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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. We measured hs-cTnI (high-sensitivity cardiac troponin I), hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) 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 NTproBNP 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. [ABSTRACT FROM AUTHOR]

BACKGROUND The prognostic utility of NT-proBNP in the setting of hypertension has not been well-characterized in the general US adult population. METHODS We measured NT-proBNP in stored blood samples collected from participants 1 year or older who participated in the 1999–2004 National Health and Nutrition Examination Survey. In adults 20 years or older without a history of cardiovascular disease, we assessed the prevalence of elevated NT-pro-BNP by blood pressure (BP) treatment and control categories. We examined the extent to which NT-proBNP identifies participants at higher risk for mortality across BP treatment and control categories. RESULTS Among US adults without CVD, the prevalence of elevated NT-proBNP (≥125 pg/ml) was 27.2% among those with untreated hypertension, 24.9% among those with treated controlled hypertension, and 43.3% among those with treated uncontrolled hypertension. Over a median follow-up of 17.3 years and after adjusting for demographic and clinical risk factors, US adults with treated controlled hypertension and elevated NT-proBNP had increased risk of all-cause mortality (HR 2.29, 95% CI 1.79, 2.95) and cardiovascular mortality (HR 3.83, 95% CI 2.34, 6.29), compared to adults without hypertension and with low levels of NT-proBNP (<125 pg/ml). Across all levels of SBP and irrespective of antihypertensive medication use, elevated NT-proBNP was associated with an increased risk of mortality, compared to low levels of NT-proBNP. CONCLUSIONS Among a general population of adults free of CVD, NT-proBNP can provide additional prognostic information within and across categories of BP. Measurement of NT-proBNP may have potential for clinical use to optimize hypertension treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits. METHODS The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45–64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex. RESULTS Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex. CONCLUSIONS In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events. [ABSTRACT FROM AUTHOR]

The article focuses on examining the potential of 1,5-anhydroglucitol (1,5-AG) as a biomarker for sodium-glucose cotransporter 2 inhibitor (SGLT2i) adherence in adults with type 2 diabetes. Topics include how 1,5-AG reflects hyperglycemia episodes, the mechanism of action of SGLT2i medications, and the comparison of serum 1,5-AG concentrations between SGLT2i users and nonusers, suggesting significantly lower levels among SGLT2i users.

Background: There is limited community-based data on the association of hypoglycemia with cardiovascular events among older individuals, who are particularly susceptible to hypoglycemia. Methods: We conducted a prospective cohort analysis of adults with diabetes aged ≥70 years from the Atherosclerosis Risk in Communities (ARIC) Study (baseline visit 5, 2011-2013). History of severe hypoglycemia was defined using first position ICD-9 codes from prior hospitalizations, emergency department visits, and ambulance calls through June 1, 2011. We evaluated the rate of cardiovascular events (myocardial infarction, fatal coronary heart disease, stroke or heart failure) and mortality (follow-up through December 31, 2017), using negative binomial and Cox proportional hazards regression models. Results: Among 2,194 participants with diabetes (mean age: 75 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia. During a median follow-up of 5.4 years, a history of severe hypoglycemia was strongly associated with cardiovascular disease (incident and recurrent) and death (Table). Conclusions: Our findings suggest potential cardiovascular benefits of severe hypoglycemia prevention among older individuals and provide strong evidence for relaxing the targets of blood glucose control among older individuals. Disclosure: J.B. Echouffo Tcheugui: None. N.R. Daya: None. O. Tang: None. B. Windham: None. A. Shah: Advisory Panel; Self; Philips Ultrasound. Consultant; Self; Bellerophon. Other Relationship; Self; Novartis Pharmaceuticals Corporation. E. Selvin: None. [ABSTRACT FROM AUTHOR]

Populations in economic transition have a high diabetes prevalence even at lower body mass indices (BMI). We compared diabetes incidence in South Asians ≥45 years in urban India (Delhi and Chennai) and Pakistan (Karachi) with blacks and whites in U.S. Prospective analyses were done using data from the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=3,136), and the Atherosclerosis Risk in Communities Study (ARIC, blacks, n=3,059; whites, n=9,924). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. South Asians were less obese than blacks and whites (BMI, kg/m2: 24.9 vs. 28.2 vs. 26.0; Waist, cms 87.5 vs.97.5 vs. 95.2). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) in South Asian men was similar to blacks and 1.6 times than whites (26.0, 22.2-29.8 vs. 26.2, 22.7-29.7 vs. 16.1, 14.8-17.4); and in South Asian women slightly higher than blacks and 3 times than whites (31.9, 27.5-36.2 vs. 28.6, 25.7-31.6 vs. 11.3, 10.2-12.3). In those with BMI <25 kg/m2, the diabetes risk was 2.6 times higher in South Asian men, and 5.3 times in women than in whites. In those with BMI ≥30 kg/m2, diabetes incidence in South Asian men and women were 2.6 and 2.1 times higher than in whites. Adults in urban India/Pakistan have higher diabetes incidence than U.S. whites. Even nonobese South Asian adults have markedly higher risk of diabetes compared to whites. Disclosure: K. Narayan: None. D. Kondal: None. N.R. Daya: None. S.A. Patel: None. M. Deepa: None. R. Anjana: None. L.R. Staimez: None. U. Gujral: None. S. Kobes: None. R. Shivashankar: None. M.K. Ali: None. M. Kadir: None. D. Prabhakaran: None. R.L. Hanson: None. V. Mohan: None. E. Selvin: None. N. Tandon: None. Funding: National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024) [ABSTRACT FROM AUTHOR]