Release time：2024-09-13 Source：Xurui Biotechnology
Hypertension mediated organ damage (HMOD) refers to the structural or functional changes in the arterial vascular system and/or its supply organs caused by long-term or severe blood pressure elevation, resulting in organic damage or functional disorders of target organs, mainly involving organs such as the heart, kidneys, brain, eyes, and aorta. In evaluating how to diagnose hypertension mediated cardiac injury, the 2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension states that relevant evidence suggests that levels of cardiac biomarkers, particularly high-sensitivity cardiac troponin and B-type natriuretic peptide/N-terminal pro brain natriuretic peptide, are important auxiliary diagnostic indicators for myocardial injury and cardiac function assessment.
The guidelines mention in the additional risk decision tests section that coronary artery calcification (CAC) score can improve the ability to predict cardiovascular disease risk, and detection of plaques inside or outside the carotid artery and femoral artery can also improve the ability to predict cardiovascular disease risk. Meanwhile, arterial stiffness assessed by pulse wave velocity (PWV) is associated with an increased risk of cardiovascular disease events and can improve the ability to stratify cardiovascular disease risk. In addition, relevant evidence suggests that elevated levels of cardiac biomarkers, particularly high-sensitivity cardiac troponin and B-type natriuretic peptide/N-terminal pro brain natriuretic peptide, are also important and effective risk stratification factors.
It is worth noting that these cardiac biomarkers can not only be regarded as the markers of HMOD, but also may be elevated due to other reasons (such as atherosclerosis or arrhythmia) in addition to hypertension, so they may be helpful for cardiovascular disease risk assessment of hypertension patients with other complications.
Therefore, the guidelines recommend that, after comprehensive consideration of 10-year CVD prediction risk and non-traditional CVD risk adjustment factors, if it is still difficult to determine antihypertensive treatment decisions based on risk stratification for patients with elevated blood pressure, biomarkers such as hs cTnI testing or other examination methods can be used to improve the risk stratification of patients with a critical increase in 10-year cardiovascular disease risk (5% to<10%) [1] (IIb, B).
Meanwhile, the guidelines indicate that hs cTn is one of the indicators for evaluating hypertension mediated cardiac injury, with a specific reference threshold exceeding the 99th percentile reference upper limit (99th URL) (Figure 1).
Figure 1: Cardiac biomarkers and reference thresholds for hypertension mediated cardiac injury
The new guidelines provide us with a new perspective on the role of hs cTnI in clinical diagnosis. Previously, we believed that its main purpose was to evaluate acute coronary syndrome (ACS), but now it also has important specific application value in cardiovascular risk stratification in the general population
● The detection rate of hs cTn is very high in symptomatic and asymptomatic individuals, and it is positively correlated with gender, age, cardiovascular risk factors (hypertension, diabetes, obesity, etc.) and cardiac function (left ventricular weight, left ventricular systolic, diastolic function index, etc.).
In the general population, even a slight increase in hs cTn within the normal range (i.e. below the 99th percentile) can predict the long-term risk of cardiovascular disease and mortality in asymptomatic individuals. On the contrary, individuals with hs cTn levels that are close to or lower than LoD have lower cardiovascular risk.
In addition, hs cTn can also respond to cardiovascular risk interventions such as statin therapy, lifestyle changes, or weight control, and its value is parallel to cardiovascular risk adjustment.
The combination of hs cTn with existing cardiovascular risk scoring systems can also significantly improve the predictive ability of long-term cardiovascular risk.
In clinical applications, laboratories should have sufficient communication with clinicians to enable them to understand the methodological performance characteristics, the performance and application scenarios of hs cTnI, the clinical significance of continuous dynamic monitoring of diagnostic process baseline and change values, and application precautions. Specifically, it may involve:
How should the hs cTn specific risk stratification cutoff value be set for individuals with high cardiovascular risk? Do we need to specifically consider factors such as the patient's gender, age, etc? What external and internal interference factors should be noted during the 2hs cTnl detection process? What are the impacts of risk stratification on individuals with high cardiovascular risk? How should the results of the 3hs cTnI test be correctly interpreted in the risk stratification of high-risk cardiovascular populations?
Regarding the above issues, we will invite Professor Chen Xi, Director of the General Medical Health Management Center of Zhejiang Provincial People's Hospital, and Professor Zhang Litao, Director of the Laboratory Department of Wuhan Yaxin General Hospital, from 19:00 to 20:30 on September 12th. Professor Zhou Houqing, Director of the Laboratory Department of Shenzhen Hospital of Fuwai Hospital, Chinese Academy of Medical Sciences, will be the moderator to present a clinical and laboratory dialogue. They will share their insights on "Comprehensive Management Strategies for High Cardiovascular Risk Population" and "Application Value of High Sensitivity Cardiac Troponin I in Risk Stratification of High Cardiovascular Risk Population". The dialogue is full of practical knowledge,
