BACKGROUND:Guidelines recommend antihypertensive medication for adults with both stage 1 hypertension (systolic blood pressure, 130–139 mm Hg or diastolic blood pressure, 80–89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%. Cardiac biomarkers could facilitate a more targeted approach to the treatment of stage 1 hypertension.METHODS:We studied 1999 to 2004 National Health and Nutrition Examination Survey participants aged ≥20 years with untreated stage 1 hypertension without heart failure or ASCVD. hs-cTnI (high-sensitivity cardiac troponin I) and hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were measured in stored serum. We used the Pooled Cohort Equations to predict 10-year ASCVD risk. All participants had linked mortality follow-up through December 31, 2019.RESULTS:Overall, 17.5% of US adults (32.2 million) had untreated stage 1 hypertension. Among these 32.2 million persons, 15.7% had ASCVD risk ≥10%, 5.6% had elevated hs-cTnI, 4.7% had elevated hs-cTnT, and 9.5% had elevated NT-proBNP. Among adults aged 65 to 79 years with untreated stage 1 hypertension, 80.5% had ASCVD risk ≥10%, 13.0% had elevated hs-cTnI, 15.2% had elevated hs-cTnT, and 29.4% had elevated NT-proBNP. Less than half of the adults aged ≥80 years with untreated stage 1 hypertension had elevated biomarkers. The cardiovascular disease mortality rates among all adults with untreated stage 1 hypertension and with either ASCVD risk ≥10%, elevated hs-cTnI, elevated hs-cTnT, or elevated NT-proBNP were 7.51, 7.74, 8.75, and 5.87 per 1000 person-years, respectively.CONCLUSIONS:Cardiac biomarkers may be more selective for informing risk-based treatment decisions in stage 1 hypertension, particularly among adults aged ≥65 years.

中文翻译：

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模拟生物标志物引导与 ASCVD 风险引导药物治疗对美国 1 期高血压成人的影响：1999 年至 2004 年国家健康和营养检查调查

背景：指南建议患有 1 期高血压（收缩压，130-139 mm Hg 或舒张压，80-89 mm Hg）且 10 年动脉粥样硬化性心血管疾病 (ASCVD) 风险≥10% 的成人服用抗高血压药物。心脏生物标志物可以促进更有针对性的方法来治疗 1 期高血压。方法：我们研究了 1999 年至 2004 年国家健康和营养检查调查的年龄≥20 岁、未经治疗、无心力衰竭或 A​​SCVD 的 1 期高血压参与者。测量储存血清中的 hs-cTnI（高敏心肌肌钙蛋白 I）和 hs-cTnT（高敏心肌肌钙蛋白 T）和 NT-proBNP（N 端 B 型利尿钠肽原）。我们使用合并队列方程来预测 10 年 ASCVD 风险。所有参与者均进行了截至 2019 年 12 月 31 日的死亡率随访。 结果：总体而言，17.5% 的美国成年人（3220 万人）患有未经治疗的 1 期高血压。在这3220万人中，15.7%的人ASCVD风险≥10%，5.6%的人hs-cTnI升高，4.7%的人hs-cTnT升高，9.5%的NT-proBNP升高。在未治疗的 1 期高血压的 65 至 79 岁成年人中，80.5% 的 ASCVD 风险≥10%，13.0% 的 hs-cTnI 升高，15.2% 的 hs-cTnT 升高，29.4% 的 NT-proBNP 升高。患有未经治疗的 1 期高血压的 ≥80 岁成年人中，只有不到一半的生物标志物升高。所有未经治疗的 1 期高血压且 ASCVD 风险≥10%、hs-cTnI 升高、hs-cTnT 升高或 NT-proBNP 升高的所有成人的心血管疾病死亡率分别为每 1000 人 7.51、7.74、8.75 和 5.87。结论：心脏生物标志物对于 1 期高血压的基于风险的治疗决策可能更具选择性，特别是对于年龄≥65 岁的成年人。