Cardiac biomarkers, intensive blood pressure treatment and risk of adverse cardiovascular outcomes in type 2 diabetes, a secondary analysis of the ACCORD BP

项目摘要 血压（BP）控制是降低心血管疾病风险的有效预防干预措施， 特别是心力衰竭（HF）。然而，在患有2型糖尿病（T2 D）的成年人中， 预防HF的控制措施尚未建立。可能有高风险的T2 D患者， 可能会从强化BP控制中获得更大的好处。美国糖尿病协会建议 测量心脏生物标志物，特别是N-末端B型利钠肽前体（NT-proBNP）， 高灵敏度心肌肌钙蛋白T（hs-cTnT），用于识别和靶向HF高危个体 有效的治疗作为全面的HF预防策略的一部分。在这项研究中，我们建议 评估基于心脏生物标志物的方法是否可以为强化BP控制治疗决策提供信息， 高危成人T2 D患者预防HF。这项研究将检查参加ACCORD-BP试验的参与者 用可用的生物样本来测量心脏生物标志物。我们将测量NT-proBNP和hs-cTnT， 基线和随访第1年、第2年和第4年，ACCORD-BP试验参与者中， NHLBI生物储存库。NT-proBNP和hs-BNP的基线和纵向变化的预后意义 将在ACCORD-BP试验的次要分析中检查cTnT对HF风险的影响。此外，我们将 评估NT-proBNP和hs-cTnT水平是否改变强化BP控制的治疗效果。最后， 我们将检验强化血压控制可以减弱NT-proBNP和hs-BNP预期升高的假设， cTnT超过随访。这项研究将进一步加深我们对心脏起搏器临床应用的理解。 生物标志物检测作为HF预防策略的一部分，并为设计心脏 生物标志物指导的T2 D患者强化BP控制试验，用于预防HF。

Project Summary Blood pressure (BP) control is an effective preventive intervention to reduce the risk of cardiovascular disease, especially heart failure (HF). However, among adults with type 2 diabetes (T2D), the effects of intensive BP control for HF prevention are not well established. There may be high-risk individuals with T2D who are more likely to derive greater benefits from intensive BP control. The American Diabetes Association recommends measurement of cardiac biomarkers, specifically N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT), to identify and target individuals at high risk for developing HF with effective therapies as part of a comprehensive HF prevention strategy. In this study, we propose to evaluate whether a cardiac biomarker-based approach can inform intensive BP control treatment decisions in high-risk adults with T2D to prevent HF. The study will examine participants enrolled in the ACCORD-BP trial with available biospecimens to measure cardiac biomarkers. We will measure NT-proBNP and hs-cTnT at baseline and follow-up years 1, 2, and 4 among ACCORD-BP trial participants who have blood stored in the NHLBI Biorepository. The prognostic implications of baseline and longitudinal changes in NT-proBNP and hs- cTnT for HF risk will be examined in a secondary analysis of the ACCORD-BP trial. Additionally, we will evaluate whether NT-proBNP and hs-cTnT levels modify the treatment effects of intensive BP control. Finally, we will test the hypothesis that intensive BP control can attenuate the expected rise in NT-proBNP and hs- cTnT over follow-up. The proposed study will further our understanding of the clinical utility of cardiac biomarker testing as part of a HF prevention strategy and provide preliminary data for designing a cardiac biomarker-guided intensive BP control trial in T2D for HF prevention.