Systolic and Diastolic Blood Pressure, Cardiac Biomarkers, and Cardiovascular Mortality in Adults Without Cardiovascular Disease

Junchen Guo; Yan Liu; Xiaoxuan Liu; Miao Yan; Yiying Zhang; Shaohong Fang; Shanjie Wang; Bo Yu

doi:10.1016/j.jacadv.2025.101678

Systolic and Diastolic Blood Pressure, Cardiac Biomarkers, and Cardiovascular Mortality in Adults Without Cardiovascular Disease

JACC Adv. 2025 May;4(5):101678. doi: 10.1016/j.jacadv.2025.101678. Epub 2025 Apr 25.

Authors

Junchen Guo¹, Yan Liu², Xiaoxuan Liu¹, Miao Yan¹, Yiying Zhang², Shaohong Fang¹, Shanjie Wang³, Bo Yu⁴

Affiliations

¹ State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China; Department of Cardiology, Second Afﬁliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
² Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China.
³ State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China; Department of Cardiology, Second Afﬁliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: shanjie_wang@hrbmu.edu.cn.
⁴ State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China; Department of Cardiology, Second Afﬁliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: dryu_hmu@163.com.

Abstract

Background: Whether cardiac biomarkers can help provide insights into optimal blood pressure (BP) and BP-related cardiovascular mortality risk is compelling.

Objectives: The purpose of this study was to evaluate 1) the associations between systolic and diastolic blood pressure (SBP, DBP) and cardiac biomarkers; and 2) their association with cardiovascular mortality in adults without cardiovascular disease.

Methods: Cross-sectional associations between SBP, DBP and cardiac biomarkers (high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro-brain natriuretic peptide [NT-proBNP], and high-sensitivity cardiac troponin I), and prospective associations with cardiovascular mortality were analyzed using the 1999 to 2004 U.S. National Health and Nutrition Examination Survey. Prevalence rate ratio (PRR)/incidence rate ratio was estimated using weighted Poisson regression models. SBP_high was defined as ≥130 mm Hg, DBP_low was defined as <70 mm Hg; and TNT_high was defined as ≥14 ng/L.

Results: Among 11,242 adults, 2,355 deaths occurred during a median follow-up of 17.5 (IQR: 15.6-20.5) years. Compared with the reference group SBP 120 to 129 mm Hg, SBP ≥160 mm Hg had a nearly 2-fold higher adjusted PRR for hs-cTnT (1.76 [95% CI: 1.35-2.29]) and NT-proBNP (1.86 [95% CI: 1.59-2.17]). Compared with the reference group DBP 70 to 79 mm Hg, those with DBP <50 mm Hg had higher PRR for hs-cTnT (1.76 [1.39-2.23]) and NT-proBNP (1.41 [95% CI: 1.22-1.63]). Treating normal DBP, SBP, and low hs-cTnT as reference, incidence rate ratios (95% CIs) for cardiovascular mortality in SBP_highTNT_high was 2.39 (95% CI: 1.74-3.29) and for DBP_lowTNT_high was 2.27 (95% CI: 1.62-3.18).

Conclusions: Low DBP levels (<70 mm Hg) and high SBP (≥130 mm Hg) were independently associated with increased hs-cTnT or NT-proBNP. Their associations with cardiovascular mortality varied according to the presence of subclinical myocardial injury (hs-cTnT level). The combination of BP and cardiac biomarkers helps identify those at highest risk.

Keywords: N-terminal pro-brain natriuretic peptide; blood pressure; cardiac biomarker; diastolic blood pressure; high-sensitivity cardiac troponin; systolic blood pressure.