Evidence map›Paper›PMID 31707797›Full record

SynthesisCirculation2019

Incorporation of Biomarkers Into Risk Assessment for Allocation of Antihypertensive Medication According to the 2017 ACC/AHA High Blood Pressure Guideline: A Pooled Cohort Analysis.

Ambarish Pandey, Kershaw V Patel, Wanpen Vongpatanasin, Colby Ayers, Jarett D Berry, Robert J Mentz, Michael J Blaha, John W McEvoy, Paul Muntner, Muthiah Vaduganathan and 10 more

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Circulation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Ambarish PandeyDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).
Kershaw V PatelDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).
Wanpen VongpatanasinDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).
Colby AyersDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).
Jarett D BerryDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).
Robert J MentzDivision of Cardiology, Duke Clinical Research Institute, Durham, NC (R.J.M.).
Michael J BlahaJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD (M.J.B., J.W.M.).
John W McEvoyJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD (M.J.B., J.W.M.).
Paul MuntnerDepartment of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.).
Muthiah VaduganathanBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (M.V.).
Adolfo CorreaDepartment of Medicine, University of Mississippi Medical Center, Jackson (A.C., J.B.).
Javed ButlerDepartment of Medicine, University of Mississippi Medical Center, Jackson (A.C., J.B.).
Daichi ShimboDepartment of Medicine, Columbia University, New York, NY (D.S.).
Vijay NambiMichael E DeBakey Veterans Affairs hospital and Department of Medicine, Baylor College of Medicine, Houston, TX (V.N.).
Christopher deFilippiInova Heart and Vascular Institute, Falls Church, VA (C.dF.).
Stephen L SeligerDivision of Nephrology, University of Maryland School of Medicine, Baltimore (S.L.S.).
Christie M BallantyneDepartment of Medicine, Baylor College of Medicine, Houston, TX (C.M.B.).
Elizabeth SelvinDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.S.).
James A de LemosDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).
Parag H JoshiDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., K.V.P., W.V., C.A., J.D.B. J.A.d.L., P.H.J).

Funding

Tracking and Evaluation CoreU54GM115428 · NIGMS · UNIVERSITY OF MISSISSIPPI MED CTR · PI MASON, SARAH · 2016 to 2025
$38.2M
UT Southwestern Center for Translational Medicine (UL1/KL2/TL1)UL1TR001105 · NCATS · UT SOUTHWESTERN MEDICAL CENTER · PI TOTO, ROBERT DANIEL · 2013 to 2017
$24.5M
UT Southwestern O'Brien Kidney Research Core CenterP30DK079328 · NIDDK · UT SOUTHWESTERN MEDICAL CENTER · PI MOE, ORSON W · 2007 to 2021
$16.9M
REHAB-HF: A Trial of Rehabilitation Therapy in Older Acute Heart Failure PatientsR01AG045551 · NIA · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI KITZMAN, DALANE W · 2014 to 2018
$6.8M
Diabetes and Prediabetes in Older Adults in ARICR01DK089174 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI SELVIN, ELIZABETH · 2011 to 2020
$6.4M
Training in Cardiovascular ResearchT32HL125247 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI JOSEPH A HILL · 2015 to 2026
$4.3M
Hypertension, intracranial pulsatility and brain A-beta accumulation in older adultsR01AG057571 · NIA · UT SOUTHWESTERN MEDICAL CENTER · PI VONGPATANASIN, WANPEN, ZHANG, RONG · 2017 to 2021
$3.6M
Heart Failure Clinical Research Network Regional Clinical Center (U10)U10HL110312 · NHLBI · DUKE UNIVERSITY · PI FELKER, GARY M · 2012 to 2018
$3.5M
Preventing Hypertension and Sympathetic Overactivation by Targeting PhosphateR01HL133179 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI SMITH, SCOTT A, VONGPATANASIN, WANPEN · 2017 to 2020
$3.2M
Ventricular Size and Valve Calcification Measures by CTR01HL071739 · NHLBI · LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER · PI BUDOFF, MATTHEW J · 2003 to 2010
$2.0M
Biomarkers of myocardial injury, blood pressure and cardiovascular outcomes in SPRINTR01HL144112 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI BERRY, JARETT D · 2018 to 2020
$1.3M
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-FIELD CENTERN01HC095162 · HC · JOHNS HOPKINS UNIVERSITY · PI SZKLO, MOYSES A · 1999 to 2000
$694k
NCATS NIH HHS UL1 TR001105NCI NIH HHS HHSN261201800010INHLBI NIH HHS HHSN268201100005CNHLBI NIH HHS HHSN268201100005GNHLBI NIH HHS HHSN268201100005INHLBI NIH HHS HHSN268201100006CNHLBI NIH HHS HHSN268201100007CNHLBI NIH HHS HHSN268201100007INHLBI NIH HHS HHSN268201100008CNHLBI NIH HHS HHSN268201100008INHLBI NIH HHS HHSN268201100009CNHLBI NIH HHS HHSN268201100009INHLBI NIH HHS HHSN268201100010CNHLBI NIH HHS HHSN268201100011CNHLBI NIH HHS HHSN268201100011INHLBI NIH HHS HHSN268201100012CNHLBI NIH HHS HHSN268201200012INHLBI NIH HHS HHSN268201800010INHLBI NIH HHS HHSN268201800011CNHLBI NIH HHS HHSN268201800011INHLBI NIH HHS HHSN268201800012CNHLBI NIH HHS HHSN268201800012INHLBI NIH HHS HHSN268201800014CNHLBI NIH HHS HHSN268201800014INHLBI NIH HHS HHSN268201800015INHLBI NIH HHS L30 HL110027NHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095169NHLBI NIH HHS R01 HL071739NHLBI NIH HHS R01 HL133179NHLBI NIH HHS R01 HL144112NHLBI NIH HHS T32 HL125247NHLBI NIH HHS U10 HL110312NIA NIH HHS R01 AG045551NIA NIH HHS R01 AG057571NIDDK NIH HHS K24 DK106414NIDDK NIH HHS P30 DK079328NIDDK NIH HHS R01 DK089174NIGMS NIH HHS U54 GM115428NIMHD NIH HHS HHSN268201800013I
6 · The paper itself

Abstract

backgroundRisk for atherosclerotic cardiovascular disease was a novel consideration for antihypertensive medication initiation in the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) guideline. Whether biomarkers of chronic myocardial injury (high-sensitivity cardiac troponin T ≥6 ng/L] and stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥100 pg/mL) can inform cardiovascular (CV) risk stratification and treatment decisions among adults with elevated BP and hypertension is unclear.

methodsParticipant-level data from 3 cohort studies (Atherosclerosis Risk in Communities Study, Dallas Heart Study, and Multiethnic Study of Atherosclerosis) were pooled, excluding individuals with prevalent CV disease and those taking antihypertensive medication at baseline. Participants were analyzed according to BP treatment group from the 2017 American College of Cardiology/American Heart Association BP guideline and those with high BP (120 to 159/<100 mm Hg) were further stratified by biomarker status. Cumulative incidence rates for CV event (atherosclerotic cardiovascular disease or heart failure), and the corresponding 10-year number needed to treat to prevent 1 event with intensive BP lowering (to target systolic BP <120 mm Hg), were estimated for BP and biomarker-based subgroups.

resultsThe study included 12 987 participants (mean age, 55 years; 55% women; 21.5% with elevated high-sensitivity cardiac troponin T; 17.7% with elevated NT-proBNP) with 825 incident CV events over 10-year follow-up. Participants with elevated BP or hypertension not recommended for antihypertensive medication with versus without either elevated high-sensitivity cardiac troponin T or NT-proBNP had a 10-year CV incidence rate of 11.0% and 4.6%, with a 10-year number needed to treat to prevent 1 event for intensive BP lowering of 36 and 85, respectively. Among participants with stage 1 or stage 2 hypertension recommended for antihypertensive medication with BP <160/100 mm Hg, those with versus without an elevated biomarker had a 10-year CV incidence rate of 15.1% and 7.9%, with a 10-year number needed to treat to prevent 1 event of 26 and 49, respectively.

conclusionsElevations in high-sensitivity cardiac troponin T or NT-proBNP identify individuals with elevated BP or hypertension not currently recommended for antihypertensive medication who are at high risk for CV events. The presence of nonelevated biomarkers, even in the setting of stage 1 or stage 2 hypertension, was associated with lower risk. Incorporation of biomarkers into risk assessment algorithms may lead to more appropriate matching of intensive BP control with patient risk.

Indexed as

American Heart AssociationAdultAgedAntihypertensive AgentsBiomarkersCardiologyCohort StudiesFemaleHumansHypertensionMaleMiddle AgedNatriuretic Peptide, BrainPeptide FragmentsPractice Guidelines as TopicProspective StudiesAntihypertensive AgentsBiomarkersNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)Troponin Tbiomarkersheart failurehypertensionmyocardial infarctionrisk

Identifiers

PMID31707797
PMCPMC8330617

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.