Guo Junchen, Liu Yan, Liu Xiaoxuan, Yan Miao, Zhang Yiying, Fang Shaohong, Wang Shanjie, Yu Bo
State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China; Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China.
JACC Adv. 2025 Mar 27;4(5):101678. doi: 10.1016/j.jacadv.2025.101678.
Whether cardiac biomarkers can help provide insights into optimal blood pressure (BP) and BP-related cardiovascular mortality risk is compelling.
The purpose of this study was to evaluate 1) the associations between systolic and diastolic blood pressure (SBP, DBP) and cardiac biomarkers; and 2) their association with cardiovascular mortality in adults without cardiovascular disease.
Cross-sectional associations between SBP, DBP and cardiac biomarkers (high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro-brain natriuretic peptide [NT-proBNP], and high-sensitivity cardiac troponin I), and prospective associations with cardiovascular mortality were analyzed using the 1999 to 2004 U.S. National Health and Nutrition Examination Survey. Prevalence rate ratio (PRR)/incidence rate ratio was estimated using weighted Poisson regression models. SBP was defined as ≥130 mm Hg, DBP was defined as <70 mm Hg; and TNT was defined as ≥14 ng/L.
Among 11,242 adults, 2,355 deaths occurred during a median follow-up of 17.5 (IQR: 15.6-20.5) years. Compared with the reference group SBP 120 to 129 mm Hg, SBP ≥160 mm Hg had a nearly 2-fold higher adjusted PRR for hs-cTnT (1.76 [95% CI: 1.35-2.29]) and NT-proBNP (1.86 [95% CI: 1.59-2.17]). Compared with the reference group DBP 70 to 79 mm Hg, those with DBP <50 mm Hg had higher PRR for hs-cTnT (1.76 [1.39-2.23]) and NT-proBNP (1.41 [95% CI: 1.22-1.63]). Treating normal DBP, SBP, and low hs-cTnT as reference, incidence rate ratios (95% CIs) for cardiovascular mortality in SBPTNT was 2.39 (95% CI: 1.74-3.29) and for DBPTNT was 2.27 (95% CI: 1.62-3.18).
Low DBP levels (<70 mm Hg) and high SBP (≥130 mm Hg) were independently associated with increased hs-cTnT or NT-proBNP. Their associations with cardiovascular mortality varied according to the presence of subclinical myocardial injury (hs-cTnT level). The combination of BP and cardiac biomarkers helps identify those at highest risk.
心脏生物标志物能否有助于深入了解最佳血压（BP）及与血压相关的心血管死亡风险，这一问题备受关注。
本研究旨在评估1）收缩压和舒张压（SBP、DBP）与心脏生物标志物之间的关联；2）它们与无心血管疾病成年人的心血管死亡之间的关联。
利用1999年至2004年美国国家健康和营养检查调查，分析SBP、DBP与心脏生物标志物（高敏心肌肌钙蛋白T [hs-cTnT]、N末端脑钠肽前体[NT-proBNP]和高敏心肌肌钙蛋白I）之间的横断面关联，以及与心血管死亡的前瞻性关联。使用加权泊松回归模型估计患病率比（PRR）/发病率比。SBP定义为≥130 mmHg，DBP定义为<70 mmHg；TNT定义为≥14 ng/L。
在11242名成年人中，中位随访17.5（四分位间距：15.6 - 20.5）年期间有2355人死亡。与SBP为120至129 mmHg的参照组相比，SBP≥160 mmHg时hs-cTnT的校正PRR高近2倍（1.76 [95%置信区间：1.35 - 2.29]），NT-proBNP的校正PRR为1.86（95%置信区间：1.59 - 2.17）。与DBP为70至79 mmHg的参照组相比，DBP<50 mmHg者hs-cTnT的PRR较高（1.76 [1.39 - 2.23]），NT-proBNP的PRR为1.41（95%置信区间：1.22 - 1.63）。将正常DBP、SBP和低hs-cTnT作为参照，SBPTNT组心血管死亡的发病率比（95%置信区间）为2.39（95%置信区间：1.74 - 3.29），DBPTNT组为2.27（95%置信区间：1.62 - 3.18）。
低DBP水平（<70 mmHg）和高SBP（≥130 mmHg）与hs-cTnT或NT-proBNP升高独立相关。它们与心血管死亡的关联因亚临床心肌损伤（hs-cTnT水平）的存在而异。血压与心脏生物标志物的联合有助于识别风险最高的人群。
