Circulating biomarkers in the early detection of hypertensive heart disease: usefulness in the developing world

Abstract

Although the varying phenotypic spectra of hypertensive heart disease (HHD) can be assessed by electrocardiography (ECG), echocardiography and cardiovascular magnetic resonance (CMR), ECG criteria for left ventricular hypertrophy (LVH) are insensitive, while echocardiography and CMR are expensive, less readily available and often lack requisite expertise. Consequently, the use of circulating biomarkers in the diagnosis and prognostication of HHD beyond the traditional N-terminal pro- b-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) have become an attractive alternative. We carried out a PubMed and Google Scholar databases' search of original articles on circulating biomarkers used in the diagnosis of the different spectrum of HHD over the last 10 years [2005-2015] in humans. Fourteen studies met the inclusion criteria with NT-pro BNP being the most studied circulating biomarker in HHD followed by soluble ST2 (sST2). There is a lack of data on the use of circulating biomarkers in HHD. There is a need to explore further this area of investigative cardiology.

Keywords: Role; circulating biomarkers; hypertensive heart disease (HHD).

Figure 1

Flow chart of study section.

Figure 2

Box plot comparing NT-proBNP levels in patients with HT without VH, to patients with HT with VH, and patients with HHF. NT-proBNP, N-terminal pro- b-type natriuretic peptide; HT, hypertension; VH, ventricular hypertrophy; HHF, hypertensive heart failure.

Figure 3

Box plot comparing soluble ST2 levels in patients with HT, to patients with HT with LVH, and patients with HHF. HT, hypertension; VH, ventricular hypertrophy; LVH, left ventricular hypertrophy; HHF, hypertensive heart failure.

Figure 4

Schematic diagram comparing cardiac blood biomarkers soluble ST2 and NT-ProBNP in hypertensive heart disease. Soluble ST2, but not NT-ProBNP, may distinguish HT from HT with LVH (HTLVH) and absent heart failure. NT-proBNP, N-terminal pro- b-type natriuretic peptide; HT, hypertension; VH, ventricular hypertrophy; LVH, left ventricular hypertrophy; HHF, hypertensive heart failure; NT-proBNP, N-terminal pro-b-type natriuretic peptide.