Circadian blood pressure pattern modifies adropin prediction of heart failure progression in cardiometabolic hypertension
B Shelest, J Rodionova, J Kovalova, A L L A KobetsAbstract
Background
Adropin is a regulatory peptide implicated in endothelial homeostasis and metabolic balance. In cardiometabolic essential hypertension, heart failure (HF) may develop through hypertension-mediated organ damage and diastolic dysfunction. Ambulatory blood pressure monitoring (ABPM) phenotypes may modify biomarker-risk associations. The purpose was to assess whether baseline serum adropin predicts 12-month HF progression and whether associations differ by circadian blood pressure (BP) profile.
Methods
Prospective cohort of 133 patients with essential hypertension plus type 2 diabetes and increased body mass (body mass index 25 kg/m2 or higher), without prior myocardial infarction and without diagnosed HF. All underwent 24-hour ABPM and were classified as dippers (night-time systolic BP fall 10% or more) or non-dippers (all other profiles). Baseline echocardiography and serum adropin (enzyme-linked immunosorbent assay) were obtained. HF progression at 12 months was defined as hospitalisation for HF or incident symptomatic HF (NYHA class II or higher) requiring initiation/escalation of diuretic therapy with echocardiographic abnormality. Multivariate logistic regression was used to evaluate the relationship between adropin and HF risk, adjusting for age, sex, LVEF, and comorbidities.
Results
HF progression occurred in 11/133 (8.3%): 3/71 (4.2%) among dippers and 8/62 (12.9%) among non-dippers. Baseline adropin was lower in those with HF progression versus event-free participants (2.45 (0.63) vs 3.24 (0.89) ng/mL; p=0.0004). In adjusted analyses, lower adropin predicted HF progression in dippers (odds ratio (OR) 1.31; 95% confidence interval (CI) 1.08-2.96; p=0.021), while no significant association was observed in non-dippers (OR 1.14; 95% CI 0.76-1.72; p=0.58).
Conclusions
In cardiometabolic essential hypertension, lower serum adropin is associated with higher 12-month risk of HF progression among patients with preserved nocturnal dipping. The absence of a significant association in non-dippers suggests phenotype-dependent interpretability of adropin and supports integrated risk assessment combining biomarkers with ABPM patterns.