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 控制血压(BP)是降低心血管疾病风险的有效预防性干预措施， 尤其是心力衰竭(HF)。然而，在患有2型糖尿病(T2D)的成年人中，强化BP的效果 预防心力衰竭的控制措施还不是很完善。可能有更多患有T2D的高危个体 可能会从英国石油公司的强化控制中获得更大的好处。美国糖尿病协会建议 心脏生物标志物的测定，特别是N末端前B型利钠肽(NT-proBNP)和 高敏心肌肌钙蛋白T(hs-cTnT)，用于识别和靶向患心力衰竭的高危个体 将有效的治疗作为全面预防心力衰竭战略的一部分。在这项研究中，我们建议 评估基于心脏生物标记物的方法是否可以为强化的血压控制治疗决策提供信息 高危成人使用T2D预防心力衰竭。这项研究将检查参加ACCORD-BP试验的参与者 使用可用的生物标记物来测量心脏生物标记物。我们将测定NT-proBNP和hs-cTnT ACCORD-BP试验参与者的基础和随访1、2和4年 NHLBI生物库。NT-proBNP和hs-proBNP基线和纵向变化对预后的影响 将在ACCORD-BP试验的二次分析中检查cTnT对心衰风险的影响。此外，我们还将 评估NT-proBNP和hs-cTnT水平是否改变强化血压控制的治疗效果。最后， 我们将检验这样一种假设，即加强血压控制可以抑制预期的NT-ProBNP和hs-BNP上升。 CTnT优先于随访。建议的研究将进一步加深我们对心脏的临床效用的理解。 生物标志物检测作为心力衰竭预防策略的一部分，并为设计心脏 生物标记物引导的T2D强化BP对照试验预防心力衰竭。

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.