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

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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.