Prognostic Significance of Routine Cardiac Biomarkers in Hypertension When Heart Failure Is Excluded: A Real-World Analysis of the TriNetX Database

The use of biomarkers in heart failure (HF) is long established; however, little is known about the prognostic significance of these biomarkers in hypertension when HF has been excluded. This study examined the prognostic significance of routine cardiac biomarkers (natriuretic peptides and cardiac troponins) in hypertensive patients when HF has been excluded. We analyzed electronic medical records from a global federated research network TriNetX. Cohorts were built based on biomarker-specific thresholds with 1:1 propensity-score matching. Cox proportional models were used to estimate hazard ratios with 95% confidence interval for 5-year incident major adverse cardiac events (MACE). Our analysis identified four biomarker cohorts: (a) B-type natriuretic peptide (BNP)-80,740 patients (b) N-terminal pro B-type natriuretic peptide (NT-proBNP)-46,164 patients (c) cardiac troponin T-13,785 patients, and (d) cardiac troponin I-183,346. Elevated NT-proBNP had an increased risk for MACE (HR 1.9, 95% CI 1.86, 1.96 p < 0.0001) and all-cause mortality (HR 2.13 95% CI 95% CI 2.07, 2.18 p < 0.0001) compared to those with lower levels. Similarly, hs-cTnT showed significant association with MACE (HR 1.53 95% CI 1.46, 1.61 p < 0.0001). Elevated natriuretic peptides and cardiac troponins in hypertensive patients without HF demonstrate significant risk of MACE and its individual components.