Biomarkers of myocardial injury, blood pressure and cardiovascular outcomes in SPRINT

SPRINT 中心肌损伤、血压和心血管结局的生物标志物

• 批准号: 9926727
• 负责人: Jarett D Berry
• 金额: $ 33.18万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926727
• 关键词: Address; Adult; Adverse effects; Advocate; Biological Markers; Biomedical Research; Blood Pressure; Cardiac; Cardiovascular system; Caring; Chronic; Clinical; Data; Disease Management; Event; General Population; Goals; Health Care Costs; Health Policy; Heart Injuries; Heart failure; High Prevalence; Home environment; Hypertension; Individual; Link; Literature; Measures; Mediating; Medical; Medical center; Monitor; Organ; Outcome; Participant; Population; Precision Medicine Initiative; Public Health; Research; Risk; Stress; Target Populations; Therapeutic Intervention; Troponin; Work; base; blood pressure regulation; cardiovascular risk factor; clinically relevant; disease phenotype; disorder prevention; follow-up; health application; high risk; hypertension control; hypertension treatment; improved; innovation; interest; mortality; myocardial injury; novel; patient oriented; personalized medicine; population health; precision medicine; primary outcome; pro-brain natriuretic peptide (1-76); response; tool; treatment as usual; treatment strategy

Abstract Recently, the SPRINT trial demonstrated that compared with standard blood pressure treatment, intensive treatment reduced global CVD while increasing clinically-relevant adverse effects. Broad application and extension of the SPRINT trial results will create enormous practical challenges. Thus, there is a critical need to develop personalized and pragmatic approaches to BP treatment that would optimize the identification of individuals that would receive the greatest benefit from intensive BP treatment. Biomarkers that reflect intermediate disease phenotypes may represent powerful tools to guide hypertension treatment given their strong association with clinical outcomes and the feasibility of widespread application. Prior literature suggests that both high sensitivity cardiac troponin (hs-cTnT) and N-terminal-pro-BNP (NT-proBNP) characterize individuals at high risk for both HF and CVD mortality, the clinical outcomes most robustly reduced by intensive BP control in SPRINT. In addition to baseline biomarker levels, increases in hs-cTnT or NTproBNP are associated with increased risk for cardiovascular mortality and heart failure, whereas decreases in these markers are associated with lower event rates. Therefore, these observations suggest that these biomarkers may identify high-risk individuals who merit more intensive BP goals and may be useful for monitoring the response to BP lowering. Therefore, we propose to measure hs-cTnT and NT- proBNP at baseline, year 1, and year 2 in the SPRINT trial to accomplish the following aims: Specific Aim 1: Determine if SPRINT participants with early cardiovascular end organ damage derive greater benefit from intensive BP lowering (augmented reduction in SPRINT primary outcome); Specific Aim 2: Among SPRINT trial participants, determine the impact of intensive BP control on hs-cTnT and NT-proBNP changes from baseline to follow-up (year 1 & 2). The findings from this research will help identify those individuals most likely to benefit from intensive BP control, providing a novel, effective, and inexpensive personalized BP management strategy that can be implemented broadly.

摘要 最近，Sprint试验表明，与标准血压相比 治疗，强化治疗减少了全球心血管疾病，同时增加了与临床相关的不良反应 效果。Sprint试验成果的广泛应用和推广将产生巨大的 实际的挑战。因此，迫切需要发展个性化和实用化 BP治疗方法将优化个人身份识别，这将 从密集的BP治疗中获得最大的好处。反映中间体的生物标志物 疾病表型可能是指导高血压治疗的有力工具，因为它们 与临床结果和广泛应用的可行性密切相关。之前 文献表明，高敏心肌肌钙蛋白(hs-cTnT)和N-末端前-BNP (NT-proBNP)是心力衰竭和心血管疾病死亡的高危个体的特征，临床 在Sprint项目中，强化BP控制效果最明显。除基线外 生物标志物水平、hs-cTnT或NTproBNP的增加与高血压的风险增加相关 心血管死亡率和心力衰竭，而这些标记物的减少与 更低的事故率。因此，这些观察结果表明，这些生物标志物可能 确定符合更严格BP目标的高危个人，并可能对 监测对血压下降的反应。因此，我们建议测量hs-cTnT和NT- ProBNP在Sprint试验中的基线、第一年和第二年，以实现以下目标： 具体目标1：确定短跑运动员是否有早期心血管终末器官损伤 从密集的降压中获得更大的好处(主要冲刺的降压幅度更大 结果)；具体目标2：在Sprint试验参与者中，确定强化试验的影响 血压控制hs-cTnT和NT-proBNP从基线到随访(第1年和第2年)变化。这个 这项研究的发现将有助于确定哪些人最有可能从密集的 BP控制，提供了一种新颖、有效、廉价的个性化BP管理策略 这一点可以广泛实施。

项目成果

High-Sensitivity Cardiac Troponins I and T and Cardiovascular Outcomes: Findings from the Systolic Blood Pressure Intervention Trial (SPRINT).

高敏心肌肌钙蛋白 I 和 T 与心血管结果：收缩压干预试验 (SPRINT) 的结果。

• DOI: 10.1093/clinchem/hvad209
• 发表时间: 2024
• 期刊: Clinical chemistry
• 影响因子: 9.3
• 作者: Jia,Xiaoming;Nambi,Vijay;Berry,JarettD;Dalmacy,Djhenne;Ascher,SimonB;Taylor,AddisonA;Hoogeveen,RonC;deLemos,JamesA;Ballantyne,ChristieM
• 通讯作者: Ballantyne,ChristieM

Effect of Intensive Blood Pressure Control on Troponin and Natriuretic Peptide Levels: Findings From SPRINT.

强化血压控制对肌钙蛋白和利尿钠肽水平的影响：来自 SPRINT 的研究结果。

• DOI: 10.1161/circulationaha.122.059960
• 发表时间: 2023
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Berry,JarettD;Chen,Haiying;Nambi,Vijay;Ambrosius,WalterT;Ascher,SimonB;Shlipak,MichaelG;Ix,JoachimH;Gupta,Rajesh;Killeen,Anthony;Toto,RobertD;Kitzman,DalaneW;Ballantyne,ChristieM;deLemos,JamesA
• 通讯作者: deLemos,JamesA

Kidney Function Specific Reference Limits for N-terminal Pro Brain Natriuretic Peptide and High Sensitivity Troponin T: The Systolic Blood Pressure Intervention Trial.

肾功能的特异性参考限为N末端脑脑脂肪酸肽和高灵敏度Troponin t：收缩压干预试验。

• DOI: 10.1016/j.xkme.2022.100517
• 发表时间: 2022-09
• 期刊: KIDNEY MEDICINE
• 影响因子: 3.9
• 作者: Bansal, Nisha;Katz, Ronit;Seliger, Stephen;deFilippi, Christopher;Wettersten, Nicholas;Zelnick, Leila R.;Berry, Jarett D.;de Lemos, James A.;Christenson, Robert;Killeen, Anthony A.;Shlipak, Michael G.;Ix, Joachim H.
• 通讯作者: Ix, Joachim H.

Comparisons of multiple troponin assays for detecting chronic myocardial injury in the general population: redundant or complementary?

检测一般人群慢性心肌损伤的多种肌钙蛋白检测的比较：冗余还是互补？

• DOI: 10.1093/eurheartj/ehad414
• 发表时间: 2023
• 期刊: European heart journal
• 影响因子: 39.3
• 作者: deLemos,JamesA;Berry,JarettD
• 通讯作者: Berry,JarettD