Importance Elevated high-sensitivity cardiac troponin T (hscTnT) and N-terminal pro–B-type natriuretic peptide (NTproBNP) levels are associated with risk of heart failure (HF) and mortality among individuals in the general population. However, it is unknown if this risk is modifiable.

Objective To test the hypothesis that elevated hscTnT and NTproBNP levels would identify individuals with the greatest risk for mortality and HF and the largest benefit associated with intensive systolic blood pressure (SBP) lowering.

Design, Setting, and Participants This is a nonprespecified post hoc analysis of the multicenter, prospective, randomized clinical Systolic Blood Pressure Intervention Trial (SPRINT), conducted from October 20, 2010, to August 20, 2015. A total of 9361 patients without diabetes with increased risk for cardiovascular disease were randomized to receive intensive vs standard SBP lowering. Statistical analysis was performed on an intention-to-treat basis from September 30, 2019, to July 29, 2021.

Interventions Participants were randomized to undergo intensive (<120 mm Hg) or standard (<140 mm Hg) SBP lowering. High-sensitivity cardiac troponin T and NTproBNP levels were measured from stored specimens collected at enrollment, with elevated levels defined as 14 ng/L or more for hscTnT (to convert to micrograms per liter, multiply by 0.001) and 125 pg/mL or more for NTproBNP (to convert to nanograms per liter, multiply by 1.0).

Main Outcomes and Measures The primary outcome of this ancillary study was HF and mortality.

Results Of the 9361 participants enrolled in SPRINT, 8828 (5578 men [63.2%]; mean [SD] age, 68.0 [9.5] years) had measured hscTnT levels and 8836 (5585 men [63.2%]; mean [SD] age, 68.0 [9.5] years) had measured NTproBNP levels; 2262 of 8828 patients (25.6%) had elevated hscTnT levels, 3371 of 8836 patients (38.2%) had elevated NTproBNP, and 1411 of 8828 patients (16.0%) had both levels elevated. Randomization to the intensive SBP group led to a 4.9% (95% CI, 1.7%-7.5%) absolute risk reduction (ARR) over 4 years in death and HF (421 events) for those with elevated hscTnT and a 1.7% (95% CI, 0.7%-2.5%) ARR for those without elevated levels. Similarly, for those with elevated NTproBNP, the ARR for death and HF over 4 years was 4.6% (95% CI, 2.3%-6.5%) vs 1.8% (95% CI, 0.9%-2.5%) in those without elevated levels. For those with elevated levels of both biomarkers, the ARR for death and HF over 4 years was 7.8% (95% CI, 3.3%-11.3%) vs 1.7% (95% CI, 0.8%-2.3%) in those with neither biomarker elevated. No significant treatment group by biomarker category interactions were detected.

Conclusions and Relevance Intensive SBP control led to large absolute differences in death and HF among patients with abnormal hscTnT and NTproBNP levels. These findings demonstrate that risk associated with elevation of these biomarkers is modifiable with intensive BP control. A prospective, randomized clinical trial is needed to evaluate whether these biomarkers may help guide selection of patients for intensive SBP lowering.

Trial Registration ClinicalTrials.gov Identifier: NCT01206062

重要性 高敏心肌肌钙蛋白 T (hscTnT) 和 N 末端 B 型钠尿肽原 (NTproBNP) 水平升高与一般人群中心力衰竭 (HF) 和死亡率的风险相关。然而，尚不清楚这种风险是否可以改变。

目的 检验以下假设：hscTnT 和 NTproBNP 水平升高可识别死亡和心力衰竭风险最大的个体，以及与强化收缩压 (SBP) 降低相关的最大益处。

设计、设置和参与者 这是对 2010 年 10 月 20 日至 2015 年 8 月 20 日进行的多中心、前瞻性、随机临床收缩压干预试验 (SPRINT) 进行的非预先指定的事后分析。总共 9361 名非糖尿病患者心血管疾病风险增加的患者被随机分配接受强化降压治疗与标准降压治疗。统计分析是在2019年9月30日至2021年7月29日的意向治疗基础上进行的。

干预措施 参与者被随机分配接受强化（<120 mm Hg）或标准（<140 mm Hg）SBP 降低。高敏心肌肌钙蛋白 T 和 NTproBNP 水平是从入组时收集的储存样本中测量的，hscTnT 的升高水平定义为 14 ng/L 或更高（转换为微克/升，乘以 0.001）和 125 pg/mL 或更高NTproBNP（转换为纳克每升，乘以 1.0）。

主要结果和措施 这项辅助研究的主要结果是心力衰竭和死亡率。

结果 在参加 SPRINT 的 9361 名参与者中，8828 名（5578 名男性 [63.2%]；平均 [SD] 年龄，68.0 [9.5] 岁）测量了 hscTnT 水平，8836 名（5585 名男性 [63.2%]；平均 [SD] 年龄，68.0 [9.5] 岁）测量了 hscTnT 水平。 68.0 [9.5] 岁）测量过 NTproBNP 水平；8828 名患者中的 2262 名患者 (25.6%) 的 hscTnT 水平升高，8836 名患者中的 3371 名患者 (38.2%) 的 NTproBNP 水平升高，8828 名患者中的 1411 名患者 (16.0%) 两种水平均升高。随机分配到强化 SBP 组可使 hscTnT 升高的患者在 4 年内死亡和心力衰竭（421 例事件）的绝对风险 (ARR) 降低 4.9%（95% CI，1.7%-7.5%），而 hscTnT 升高的患者的死亡和心力衰竭（ARR）绝对风险降低 1.7%（95 % CI, 0.7%-2.5%) ARR 对于那些没有升高的水平。同样，对于 NTproBNP 升高的患者，4 年以上死亡和心力衰竭的 ARR 为 4.6%（95% CI，2.3%-6.5%），而水平未升高的患者则为 1.8%（95% CI，0.9%-2.5%） 。对于两种生物标志物水平均升高的患者，4 年以上死亡和心力衰竭的 ARR 为 7.8%（95% CI，3.3%-11.3%），而两种生物标志物水平均未升高的患者为 1.7%（95% CI，0.8%-2.3%）生物标志物升高。未检测到生物标志物类别之间显着的治疗组相互作用。

结论和相关性 在 hscTnT 和 NTproBNP 水平异常的患者中，强化 SBP 控制导致死亡和心力衰竭的绝对差异较大。这些发现表明，与这些生物标志物升高相关的风险可以通过强化血压控制来改变。需要进行前瞻性随机临床试验来评估这些生物标志物是否有助于指导选择强化降低收缩压的患者。

试验注册 ClinicalTrials.gov 标识符：NCT01206062