Associations of High-Sensitivity Troponin and Natriuretic Peptide Levels With Serious Adverse Events in SPRINT

Simon B. Ascher, Rebecca Scherzer, Jame A. de Lemos, Michelle M. Estrella, Vasantha K. Jotwani, Pranav S. Garimella, Alexander L. Bullen, Walter T. Ambrosius, Christie M. Ballantyne, Vijay Nambi, Anthony A. Killeen, Joachim H. Ix, Michael G. Shlipak, Jarett D. Berry

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Assessing the risk of serious adverse events (SAEs) during hypertension treatment is important for understand-ing the benefit-harm trade-offs of lower blood pressure goals. It is unknown whether high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) provide information about SAEs. METHODS AND RESULTS: In SPRINT (Systolic Blood Pressure Intervention Trial), hs-cTnT and NT-proBNP were measured at baseline in 8828 (94.3%) and 8836 (94.4%) participants, respectively. Multivariable Cox proportional hazards models were used to evaluate hs-cTnT and NT-proBNP associations with a composite of SPRINT’s SAEs of interest: hypotension, syncope, bradycardia, acute kidney injury, electrolyte abnormalities, and injurious falls. Elevations in hs-cTnT and NT-proBNP were associated with increased composite SAE risk (hazard ratio [HR] per 2-fold higher hs-cTnT: 1.15; 95% CI, 1.06‒1.25; HR per 2-fold higher NT-proBNP: 1.09; 95% CI, 1.05‒1.14). Compared with both hs-cTnT and NT-proBNP in the lower tertiles, both biomarkers in the highest tertile was associated with increased composite SAE risk (HR, 1.56; 95% CI, 1.32‒1.84). Composite SAE risk was higher in the intensive-treatment group than in the standard-treatment group for participants with both biomark-ers in the lower tertiles, but similar between treatment groups for participants with both biomarkers in the highest tertile (P for interaction=0.008). CONCLUSIONS: Elevations in hs-cTnT and NT-proBNP individually and in combination are associated with higher composite SAE risk in SPRINT. The differential impact of blood pressure treatment on SAE risk across combined biomarker categories may have implications for identifying individuals with more favorable benefit-harm profiles for intensive blood pressure lowering.

Original languageEnglish (US)
Article numbere023314
JournalJournal of the American Heart Association
Issue number6
StatePublished - Mar 15 2022

Bibliographical note

Funding Information:
This ancillary study was supported by the National Heart, Lung, and Blood Institute (1R01HL144112-01 for JDB), the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK098234 for MGS/JHI and K24DK110427 for JHI) and the American Heart Association (14EIA18560026 for JHI). Analytical reagents for hs-cTnT and NT-pro-BNP measurements were donated by Roche (Indianapolis, IN).

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


  • adverse events
  • brain natriuretic peptide
  • hypertension
  • troponin
  • Peptide Fragments
  • Humans
  • Proportional Hazards Models
  • Troponin T
  • Vasodilator Agents
  • Troponin
  • Natriuretic Peptide, Brain
  • Biomarkers

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


Dive into the research topics of 'Associations of High-Sensitivity Troponin and Natriuretic Peptide Levels With Serious Adverse Events in SPRINT'. Together they form a unique fingerprint.

Cite this