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Published in: Current Hypertension Reports 3/2018

01-03-2018 | Hypertension and Emergency Medicine (T Rainer and P Levy, Section Editors)

Novel Biomarkers to Detect Target Organ Damage in Acute Hypertension

Authors: Stephen Boone, Dick Kuo

Published in: Current Hypertension Reports | Issue 3/2018

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Abstract

Purpose of Review

Early lowering of blood pressure is advised for patients with severe hypertension associated with signs of impending or progressive organ damage, whereas aggressive treatment is not recommended in patients with asymptomatic severe hypertension. As treatment goals for asymptomatic hypertension and true hypertensive emergency drastically differ, it is essential to identify patients with evidence of impending or progressive organ damage. Biomarkers may assist providers in identifying high-risk patients who would benefit from early blood pressure reduction.

Recent Findings

In this review, we discuss both currently available and investigational biomarkers that may help identify patients who might benefit from more aggressive therapy. We focus on serum and urinary biomarkers associated with acute cardiovascular, renal, and cerebrovascular damage.

Summary

There is a dearth of literature regarding the use of biomarkers to assess acute hypertension-related target organ damage. We are primarily forced to draw conclusions on the use of biomarkers from studies of related conditions such as acute heart failure. Further research is needed on the clinical significance of abnormal levels of novel biomarkers of renal, cardiac, and cerebral dysfunction in the setting of severe hypertension, particularly in those patients without overt clinical signs of organ failure.
Literature
4.
go back to reference Janke AT, CD MN, Brody AM, Welch RD, Levy PD. Trends in the incidence of hypertensive emergencies in US emergency departments from 2006 to 2013. J Am Heart Assoc. 2016 Dec 5;5(12) Janke AT, CD MN, Brody AM, Welch RD, Levy PD. Trends in the incidence of hypertensive emergencies in US emergency departments from 2006 to 2013. J Am Heart Assoc. 2016 Dec 5;5(12)
6.
go back to reference •• Levy PD, Mahn JJ, Miller J, et al. Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort. Am J Emerg Med. 2015;33(9):1219–24. This paper demonstrated that, regardless of the degree of blood pressure elevation, patients presenting to the emergency department with severe hypertension without organ damage did not derive benefit from early initiation of antihypertensive therapy. CrossRefPubMed •• Levy PD, Mahn JJ, Miller J, et al. Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort. Am J Emerg Med. 2015;33(9):1219–24. This paper demonstrated that, regardless of the degree of blood pressure elevation, patients presenting to the emergency department with severe hypertension without organ damage did not derive benefit from early initiation of antihypertensive therapy. CrossRefPubMed
7.
go back to reference Mahajan N, Mehta Y, Rose M, et al. Elevated troponin level is not synonymous with myocardial infarction. Int J Cardiol. 2006;111:442–9.CrossRefPubMed Mahajan N, Mehta Y, Rose M, et al. Elevated troponin level is not synonymous with myocardial infarction. Int J Cardiol. 2006;111:442–9.CrossRefPubMed
8.
go back to reference Taniguchi R, Sato Y, Nishio Y, et al. Measurements of baseline and follow-up concentrations of cardiac troponin-T and brain natriuretic peptide in patients with heart failure from various etiologies. Heart Vessel. 2006;21:344–9.CrossRef Taniguchi R, Sato Y, Nishio Y, et al. Measurements of baseline and follow-up concentrations of cardiac troponin-T and brain natriuretic peptide in patients with heart failure from various etiologies. Heart Vessel. 2006;21:344–9.CrossRef
13.
go back to reference Kertai MD, Boersma E, Klein J, et al. Long-term prognostic value of asymptomatic cardiac troponin T elevations in patients after major vascular surgery. Eur J Vasc Endovasc Surg. 2004;28:59–66.CrossRefPubMed Kertai MD, Boersma E, Klein J, et al. Long-term prognostic value of asymptomatic cardiac troponin T elevations in patients after major vascular surgery. Eur J Vasc Endovasc Surg. 2004;28:59–66.CrossRefPubMed
15.
go back to reference • Afonso L, Bandaru H, Rathod A, Badheka A, Kizilbash A, et al. Prevalence, determinants, and clinical significance of cardiac troponin-I elevation in individuals admitted for a hypertensive emergency. J Clin Hypertens. 2011;13:551–6. This study is notable for both highlighting a very high mortality rate among patients with hypertensive emergency and also for demonstrating that elevated troponin levels in acute hypertension, absent acute coronary syndrome, may not be independently associated with increased mortality. CrossRef • Afonso L, Bandaru H, Rathod A, Badheka A, Kizilbash A, et al. Prevalence, determinants, and clinical significance of cardiac troponin-I elevation in individuals admitted for a hypertensive emergency. J Clin Hypertens. 2011;13:551–6. This study is notable for both highlighting a very high mortality rate among patients with hypertensive emergency and also for demonstrating that elevated troponin levels in acute hypertension, absent acute coronary syndrome, may not be independently associated with increased mortality. CrossRef
16.
go back to reference Maludum O, Shah M, Mezue K, Biso S, Rodriguez-Ziccardi M, et al. Factors that influence decision for ischemic work-up in hypertensive emergency. Int J Cardiol. 2016 Jul 1;214:331–2.CrossRefPubMed Maludum O, Shah M, Mezue K, Biso S, Rodriguez-Ziccardi M, et al. Factors that influence decision for ischemic work-up in hypertensive emergency. Int J Cardiol. 2016 Jul 1;214:331–2.CrossRefPubMed
18.
go back to reference Pascual-Figal DA, Manzano-Fernández S, Boronat M, Casas T, Garrido IP, et al. Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure. Eur J Heart Fail. 2011;13(7):718.CrossRefPubMed Pascual-Figal DA, Manzano-Fernández S, Boronat M, Casas T, Garrido IP, et al. Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure. Eur J Heart Fail. 2011;13(7):718.CrossRefPubMed
19.
go back to reference Peacock WF, De Marco T, Fonarow GC, et al. Cardiac troponin and outcomes in acute heart failure. N Engl J Med. 2008;258:2117–26.CrossRef Peacock WF, De Marco T, Fonarow GC, et al. Cardiac troponin and outcomes in acute heart failure. N Engl J Med. 2008;258:2117–26.CrossRef
23.
go back to reference •• Peacock F, Amin A, Granger CB, Pollack CV, Levy P, et al. Hypertensive heart failure: patient characteristics, treatment, and outcomes. Am J Emerg Med. 2011;(8):855–62. This retrospective study of over 12,000 patients is perhaps the largest and best study on the prognostic significance of abnormal biomarkers (natriuretic peptides) in patients with hypertensive emergency. •• Peacock F, Amin A, Granger CB, Pollack CV, Levy P, et al. Hypertensive heart failure: patient characteristics, treatment, and outcomes. Am J Emerg Med. 2011;(8):855–62. This retrospective study of over 12,000 patients is perhaps the largest and best study on the prognostic significance of abnormal biomarkers (natriuretic peptides) in patients with hypertensive emergency.
24.
go back to reference Kato J, Tsuruda T, Kita T, Kitamura K, Eto T. Adrenomedullin: a protective factor for blood vessels. Arteriorscler Thromb Vasc Biol. 2005;25:2480–7.CrossRef Kato J, Tsuruda T, Kita T, Kitamura K, Eto T. Adrenomedullin: a protective factor for blood vessels. Arteriorscler Thromb Vasc Biol. 2005;25:2480–7.CrossRef
25.
go back to reference Funke-Kaiser A, Mann K, Colquhoun D, et al. Mid- regional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients: the LIPID study. Int J Cardiol. 2014;172:411–8.CrossRefPubMed Funke-Kaiser A, Mann K, Colquhoun D, et al. Mid- regional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients: the LIPID study. Int J Cardiol. 2014;172:411–8.CrossRefPubMed
26.
go back to reference Suberviola B, Castellanos-Ortega A, Llorca J, Ortiz F, Iglesias D, Prieto B. Prognostic value of proad- renomedullin in severe sepsis and septic shock patients with community-acquired pneumonia. Swiss Med Wkly. 2012;142:w13542.PubMed Suberviola B, Castellanos-Ortega A, Llorca J, Ortiz F, Iglesias D, Prieto B. Prognostic value of proad- renomedullin in severe sepsis and septic shock patients with community-acquired pneumonia. Swiss Med Wkly. 2012;142:w13542.PubMed
28.
go back to reference • Maisel A, Mueller C, Nowak R, Peacock WF, Landsberg JW, Ponikowski P, et al. Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (Biomarkers in ACute Heart failure) trial. J Am Coll Cardiol. 2010;55:2062–76. The BACH trial highlighted the potential prognostic implications of both MR-ProADM and Copeptin in the acute care setting. CrossRefPubMed • Maisel A, Mueller C, Nowak R, Peacock WF, Landsberg JW, Ponikowski P, et al. Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (Biomarkers in ACute Heart failure) trial. J Am Coll Cardiol. 2010;55:2062–76. The BACH trial highlighted the potential prognostic implications of both MR-ProADM and Copeptin in the acute care setting. CrossRefPubMed
29.
30.
go back to reference Maisel A, Xue Y, Shah K, Mueller C, Nowak R, et al. Increased 90-day mortality in patients with acute heart failure with elevated copeptin; secondary results from the Biomarkers in Acute Heart Failure (BACH) study. Circ Heart Fail. 2011;4:613–20.CrossRefPubMed Maisel A, Xue Y, Shah K, Mueller C, Nowak R, et al. Increased 90-day mortality in patients with acute heart failure with elevated copeptin; secondary results from the Biomarkers in Acute Heart Failure (BACH) study. Circ Heart Fail. 2011;4:613–20.CrossRefPubMed
32.
go back to reference Maisel A, Mueller C, Neath SX, Christenson RH, Morgenthaler NG. Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol. 2013;62(2):150–60.CrossRefPubMed Maisel A, Mueller C, Neath SX, Christenson RH, Morgenthaler NG. Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol. 2013;62(2):150–60.CrossRefPubMed
34.
go back to reference Villacorta H, Maisel AS. Soluble ST2 testing: a promising biomarker in the management of heart failure. Arq Bras Cardiol. 2016;106(2):145–52.PubMedPubMedCentral Villacorta H, Maisel AS. Soluble ST2 testing: a promising biomarker in the management of heart failure. Arq Bras Cardiol. 2016;106(2):145–52.PubMedPubMedCentral
36.
go back to reference Parikh R, Seliger S, Christenson R, et al. Soluble ST2 for prediction of heart failure and cardiovascular death in an elderly, community-dwelling population. J Am Heart Assoc. 2016;5:3003188.CrossRef Parikh R, Seliger S, Christenson R, et al. Soluble ST2 for prediction of heart failure and cardiovascular death in an elderly, community-dwelling population. J Am Heart Assoc. 2016;5:3003188.CrossRef
38.
go back to reference • Derhaschnig U, Testori C, Riedmueller E, et al. Decreased renal function in hypertensive emergencies. J Hum Hypertens. 2014;28(7):427–31. This is one of only a few studies to specifically address the use of urinary biomarkers (NGAL) in the setting of hypertensive emergency in the emergency department. CrossRefPubMed • Derhaschnig U, Testori C, Riedmueller E, et al. Decreased renal function in hypertensive emergencies. J Hum Hypertens. 2014;28(7):427–31. This is one of only a few studies to specifically address the use of urinary biomarkers (NGAL) in the setting of hypertensive emergency in the emergency department. CrossRefPubMed
42.
go back to reference Soto K, Coelho S, Rodrigues B, Martin H, Frade F, et al. Cystatin C as a marker of acute kidney injury in the emergency department. Clin J Am Soc Nephrol. 2010 Oct;5(10):1745–54.CrossRefPubMedPubMedCentral Soto K, Coelho S, Rodrigues B, Martin H, Frade F, et al. Cystatin C as a marker of acute kidney injury in the emergency department. Clin J Am Soc Nephrol. 2010 Oct;5(10):1745–54.CrossRefPubMedPubMedCentral
46.
go back to reference • Nickolas TL, O'Rourke MJ, Yang J, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med. 2008;148:810–9. The results of this study suggest that NGAL is highly predictive of developing acute kidney injury and also shows promise in discriminating acute kidney injury from chronic/non-progressive renal disease. CrossRefPubMedPubMedCentral • Nickolas TL, O'Rourke MJ, Yang J, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med. 2008;148:810–9. The results of this study suggest that NGAL is highly predictive of developing acute kidney injury and also shows promise in discriminating acute kidney injury from chronic/non-progressive renal disease. CrossRefPubMedPubMedCentral
47.
go back to reference Corbacioglu SK, Cevik Y, Akinci E, Uzunosmanoglu H, Dagar S, et al. Value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in distinguishing between acute kidney injury (AKI) and chronic kidney disease (CKD). Turk J Emerg Med. 2017;17(3):85–8.CrossRefPubMedPubMedCentral Corbacioglu SK, Cevik Y, Akinci E, Uzunosmanoglu H, Dagar S, et al. Value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in distinguishing between acute kidney injury (AKI) and chronic kidney disease (CKD). Turk J Emerg Med. 2017;17(3):85–8.CrossRefPubMedPubMedCentral
48.
go back to reference Palazzuoli A, Ruocco G, Pellegrini M, De Gori C, Del Castillo G, et al. Comparison of neutrophil gelatinase-associated lipocalin versus B-type natriuretic peptide and cystatin C to predict early acute kidney injury and outcome in patients with acute heart failure. Am J Cardiol. 2015 Jul 1;116(1):104–11.CrossRefPubMed Palazzuoli A, Ruocco G, Pellegrini M, De Gori C, Del Castillo G, et al. Comparison of neutrophil gelatinase-associated lipocalin versus B-type natriuretic peptide and cystatin C to predict early acute kidney injury and outcome in patients with acute heart failure. Am J Cardiol. 2015 Jul 1;116(1):104–11.CrossRefPubMed
53.
go back to reference Kadioglu T, Uzunlulu M, Yigit Kaya S, Oguz A, Gonenli G, Isbilen B, et al. Urinary kidney injury molecule-1 levels as a marker of early kidney injury in hypertensive patients. Minerva Urol Nefrol. 2016;68(5):456–61.PubMed Kadioglu T, Uzunlulu M, Yigit Kaya S, Oguz A, Gonenli G, Isbilen B, et al. Urinary kidney injury molecule-1 levels as a marker of early kidney injury in hypertensive patients. Minerva Urol Nefrol. 2016;68(5):456–61.PubMed
54.
go back to reference Bustamante A, Lopez-Cancio E, Pich S, Panalba A, Giralt D, et al. Blood biomarkers for the early diagnosis of stroke: the Stroke-Chip study. Stroke. 2017;48(9):2419–25.CrossRefPubMed Bustamante A, Lopez-Cancio E, Pich S, Panalba A, Giralt D, et al. Blood biomarkers for the early diagnosis of stroke: the Stroke-Chip study. Stroke. 2017;48(9):2419–25.CrossRefPubMed
58.
go back to reference Blum CA, Winzeler B, Nigro N, Schuetz P, Biethahn S, et al. Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study. J Headache Pain. 2017;18(1):21.CrossRefPubMedPubMedCentral Blum CA, Winzeler B, Nigro N, Schuetz P, Biethahn S, et al. Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study. J Headache Pain. 2017;18(1):21.CrossRefPubMedPubMedCentral
59.
go back to reference Bannay A, Husain A, Bohm M, Wagenpfeil S. Outcomes after hypertensive crisis: comparison between diabetics and nondiabetics. IJC Metab Endocr. 2015;7:25–30.CrossRef Bannay A, Husain A, Bohm M, Wagenpfeil S. Outcomes after hypertensive crisis: comparison between diabetics and nondiabetics. IJC Metab Endocr. 2015;7:25–30.CrossRef
Metadata
Title
Novel Biomarkers to Detect Target Organ Damage in Acute Hypertension
Authors
Stephen Boone
Dick Kuo
Publication date
01-03-2018
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 3/2018
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-018-0818-6

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