Elevated troponin predicts long-term adverse cardiovascular outcomes in hypertensive crisis: a retrospective study

• Published in: Journal of hypertension Vol. 30; no. 12; p. 2410
• Main Authors: Pattanshetty, Deepak J, Bhat, Pradeep K, Aneja, Ashish, Pillai, Dilip P
• Format: Journal Article
• Language: English
• Published: England 01.12.2012
• Subjects: Adult; Aged; Biomarkers - blood; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cerebrovascular Disorders - blood; Cerebrovascular Disorders - diagnosis; Cerebrovascular Disorders - epidemiology; Coronary Artery Disease - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Female; Humans; Hypertension - blood; Hypertension - complications; Longitudinal Studies; Male; Middle Aged; Predictive Value of Tests; Prevalence; Prognosis; Retrospective Studies; Risk Factors; Troponin - blood
• ISSN: 1473-5598
• DOI: 10.1097/HJH.0b013e3283599b4f

Hypertensive crisis is associated with poor clinical outcomes. Elevated troponin, frequently observed in hypertensive crisis, may be attributed to myocardial supply-demand mismatch or obstructive coronary artery disease (CAD). However, in patients presenting with hypertensive crisis and an elevated troponin, the prevalence of CAD and the long-term adverse cardiovascular outcomes are unknown. We sought to assess the impact of elevated troponin on cardiovascular outcomes and evaluate the role of troponin as a predictor of obstructive CAD in patients with hypertensive crisis. Patients who presented with hypertensive crisis (n = 236) were screened retrospectively. Baseline and follow-up data including the event rates were obtained using electronic patient records. Those without an assay for cardiac Troponin I (cTnI) (n = 65) were excluded. Of the remaining 171 patients, those with elevated cTnI (cTnI ≥ 0.12 ng/ml) (n = 56) were compared with those with normal cTnI (cTnI < 0.12 ng/ml) (n = 115) at 2 years for the occurrence of major adverse cardiac or cerebrovascular events (MACCE) (composite of myocardial infarction, unstable angina, hypertensive crisis, pulmonary edema, stroke or transient ischemic attack). At 2 years, MACCE occurred in 40 (71.4%) patients with elevated cTnI compared with 44 (38.3%) patients with normal cTnI [hazard ratio: 2.77; 95% confidence interval (CI): 1.79-4.27; P < 0.001]. Also, patients with elevated cTnI were significantly more likely to have underlying obstructive CAD (odds ratio: 8.97; 95% CI: 1.4-55.9; P < 0.01). In patients with hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE, and is a strong predictor of obstructive CAD.