Abstract 13966: Change in Troponin I Levels With Intensive Blood Pressure Control: A Post-Hoc Analysis of SPRINT

Abstract

Introduction: Cardiac troponin T (cTnT) levels have been shown to increase by intensive blood pressure (BP) control and longitudinal changes in cTnT predict cardiovascular disease (CVD) and mortality. However, similar data on cTnI, a specific marker of myocardial injury, are lacking. Methods: This post-hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) included participants who had cTnI values at randomization and 1-year. The cohort was stratified by change in cTnI at 1 year into ≥50% decrease, ≥50% increase, or unchanged (<50% change). The difference in log(cTnI randomization ) and log(cTnI 1 year ) was calculated. The primary outcome was CVD events. Secondary outcomes included a composite of all-cause mortality or CVD events, all-cause mortality, and a composite of heart failure or all-cause mortality. Geometric mean ratios for change in log cTnI levels with intensive BP lowering compared with standard treatment were estimated using adjusted linear regression models. Adjusted Cox models were used to assess the risk of the outcomes of interest after 1 year with the change in cTnI levels. Events within 1 year were censored. Results: Among the 8,011 participants with cTnI levels at randomization and 1 year, cTnI decreased, did not change, and increased in 393 (4.9%), 6,442 (80.4%), and 1,176 (14.7%) participants at 1 year, respectively. Compared with the standard treatment, ≥50% reduction in cTnI at 1 year was more common with intensive treatment. The intensive treatment group had a 7% decrease [geometric mean ratio: 0.93 (0.91-0.95)] in cTnI compared with the standard treatment group after adjusting for covariates. An increase in the change in log cTnI at 1 year was associated with a higher risk of incident CVD events [HR adj : 1.67 (1.36-2.05)] and the composite of all-cause mortality or CVD events[HR adj : 1.36 (1.13-1.64)]. Conclusions: cTnI levels decreased with intensive BP control and the change in cTnI at 1 year predicted incident CVD events.