Abstract 10957: Combined Assessment of High-Sensitive Troponin I and N-Terminal Pro-B-Type Natriuretic Peptide Levels Improves the Prediction of Cardiovascular Event in Outpatients With Hypertension

Abstract

Background: Hypertension is one of the most prevalent risk factors in the development of cardiovascular diseases and events. We prospectively investigated the predictive value of a combination of high-sensitive troponin I (hsTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for cardiovascular event in outpatients with hypertension. Methods: Baseline serum levels of hsTnI and NT-proBNP were measured in 701 outpatients (mean age: 68.3 years; male 71%) with hypertension, of whom 30% had a history of cardiovascular disease; 45%, diabetes; and 56%, chronic kidney disease (estimated GFR <60 mL/min/1.73 m 2 ). Left ventricular ejection fraction (LVEF) and E/e’ ratio were estimated using echocardiography with tissue Doppler imaging. Cardiovascular event was defined as cardiovascular death or admission for acute coronary syndrome, decompensated heart failure, or stroke. Results: hsTnI levels significantly correlated with NT-proBNP levels (r = 0.29; p < 0.0001). During a mean follow-up period of 959 days, there were 111 (16%) cardiovascular events, including 16 cardiovascular death cases. Multivariate Cox regression analysis, including 6 clinical, biochemical, and echocardiographic variables, identified increased hsTnI (relative risk: 1.92 per 10-fold increment; p = 0.001) and NT-proBNP levels (relative risk: 2.28 per 10-fold increment; p = 0.0001) as independent predictors of cardiovascular events. Combined hsTnI and NT-proBNP tertiles was significantly associated with cardiovascular event rates (Figure). Furthermore, adding both hsTnI and NT-proBNP levels to a baseline model improved the C-index (0.769 vs. 0.736; p = 0.005), net reclassification improvement (0.387; p < 0.0001), and integrated discrimination improvement (0.044; p = 0.001) greater than a baseline model. Conclusions: The combined assessment of hsTnI and NT-proBNP levels may improve the prediction of cardiovascular event in outpatients with hypertension.