Systolic and Diastolic Blood Pressure, Cardiac Biomarkers, and Cardiovascular Mortality in Adults Without Cardiovascular Disease

Background Whether cardiac biomarkers can help provide insights into optimal blood pressure (BP) and BP-related cardiovascular mortality risk is compelling. Objectives 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. Methods 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. SBPhigh was defined as >= 130 mm Hg, DBPlow was defined as <70 mm Hg; and TNThigh was defined as >= 14 ng/L. Results 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 SBPhighTNThigh was 2.39 (95% CI: 1.74-3.29) and for DBPlowTNThigh was 2.27 (95% CI: 1.62-3.18). Conclusions 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. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).