368 Hypertension Severity and Indeterminate High-Sensitivity Cardiac Troponin
Recommended Citation
Hawatian K, Emakhu JO, Morton T, Tuttle JE, Sidani M, Nassereddine HN, Krupp S, Cook B, Klausner H, McCord J, Miller JB. 368 Hypertension Severity and Indeterminate High-Sensitivity Cardiac Troponin. Ann Emerg Med 2025; 86(3):S160.
Document Type
Conference Proceeding
Publication Date
9-1-2025
Publication Title
Ann Emerg Med
Abstract
Study Objectives: Hypertension increases the risk of acute coronary syndrome (ACS) and major adverse cardiovascular events (MACE) (ie, myocardial infarction, all-cause mortality, and urgent revascularization), but its relationship with high-sensitivity cardiac troponin I (hs-cTnI) levels remains unclear. This study aimed to evaluate the association between hypertension severity and hs-cTnI levels and examined the impact of hypertension on 30-day MACE risk in patients with suspected ACS. Methods: We conducted a secondary analysis of a cluster randomized trial implementing a hs-cTnI early rule-out protocol. Patients were eligible for analysis who had suspected ACS and hs-cTnI testing and an electrocardiogram at a large, integrated health system consisting of ten emergency departments: five hospital-based and five free-standing facilities. We excluded patients without hs-cTnI values or values above the 99th percentile (18 ng/L). Patients were categorized into three hypertension severity groups: normotensive, defined as systolic blood pressure (SBP) less than 140 mmHg or diastolic blood pressure (DBP) less than 90 mmHg; moderately hypertensive, characterized by SBP between 140 mmHg and 180 mmHg or DBP between 90 mmHg and 110 mmHg; and severely hypertensive, where SBP was 180 mmHg or greater or DBP was 110 mmHg or greater. A generalized linear model assessed the relationship between hypertension severity and hs-cTnI levels, while multivariable logistic regression analyzed the effect of hypertension severity on 30-day MACE, adjusting for key confounders. Results: A total of 23,803 patients fit the inclusion criteria. Severe hypertension demonstrated an independent, statistically significant relationship with higher hs-cTnI levels (β = 0.0645; 95% CI: 0.047 to 0.082, p < 0.001). Likewise, severely hypertensive patients showed higher rates of elevated troponin levels (25.8% for 5-9 ng/L and 20.4% for 10-18 ng/L) compared to the other groups. After adjustment for confounders, the relationship between severe hypertension and 30-day MACE outcomes approached statistical significance (aOR: 1.61; 95% CI: 0.98–2.65, p = 0.063). Conclusion: This study revealed that patients with suspected ACS show increased hs-cTnI levels and higher 30-day MACE risks with worsening hypertension severity. Clinicians should interpret elevated troponin levels cautiously in hypertensive patients, prioritizing established risk factors such as coronary artery disease. No, authors do not have interests to disclose
Volume
86
Issue
3
First Page
S160
