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. 2025 Aug 14;38(9):697-705.
doi: 10.1093/ajh/hpaf061.

Cardiac Biomarkers in Pregnancies With and Without Hypertension

Lara C Kovell  1   2 , Mawulorm K I Denu  1 , Julia Berkowitz  1 , Sravya Shankara  3 , Cassie Shao  1 , Ekaterina Skaritanov  4 , Gianna Wilkie  2 , Tiffany A Moore Simas  2   5 , Stephen P Juraschek  6
Affiliations

Cardiac Biomarkers in Pregnancies With and Without Hypertension

Lara C Kovell et al. Am J Hypertens. .

Abstract

Background: Mechanisms of injury due to hypertension (HTN) in pregnancy remain poorly characterized. This study examined trends in markers of cardiac injury (high-sensitivity troponin I, hs-cTnI), strain (N-terminal pro-B-type natriuretic peptide, NT-proBNP), and inflammation (high-sensitivity C-reactive protein, hs-CRP) in pregnancies with and without HTN.

Methods: This prospective, 1:1 case-control study enrolled pregnant women with and without HTN (24-32 weeks gestation) from 2019 to 2022. HTN was defined by a clinical diagnosis of HTN or baseline blood pressure (BP) ≥ 140/90 mm Hg. Serum was collected at baseline, predelivery, and postpartum day 1. Mixed effects tobit models compared log-transformed hs-cTnI, NT-proBNP, and hs-CRP across HTN groups and over time, adjusted for age and body mass index.

Results: Mean baseline BP was 130.5 (17.5)/88.2 (13.5) mm Hg for the HTN group (n = 38, 86.8% chronic, 13.2% gestational HTN), and 112.0 (9.8)/70.9 (8.2) mm Hg for those without HTN (n = 38). Over pregnancy, the HTN group had higher hs-cTnI than those without HTN (2.12 [0.43] vs. 1.07 [0.25], Δ1.05 [95%CI: 0.07-2.03] ng/l). Compared to baseline, hs-cTnI increased at predelivery and postpartum for both groups. Overall, the two groups had similar NT-proBNP (HTN: 39.0 [4.5] vs. no HTN: 35.6 [4.3] pg/mL) and hs-CRP (HTN: 12.0 [1.7] vs. no HTN: 9.9 [1.5] mg/L). For both groups, NT-proBNP and hs-CRP increased from baseline to postpartum (NT-proBNP, HTN: 127% [58-227%], no HTN: 120% [51-219%]; hs-CRP: HTN: 550% [343-853%], no HTN: 664% [415-1,034%]).

Conclusion: HTN was associated with markers of cardiac injury during pregnancy, while delivery alone led to increases in markers of strain and inflammation. These biomarker changes associated with HTN in pregnancy may represent potential mechanisms to explain adverse cardiovascular events.

Keywords: N-terminal pro–B-type natriuretic peptide; blood pressure; cardiovascular disease; high-sensitivity C-reactive protein; high-sensitivity cardiac troponin I; hypertension; pregnancy.

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Conflict of interest statement

Disclosures: No relevant financial disclosures or conflicts of interest

Figures

Figure 1.
Figure 1.
Linear regression was performed using mixed effects tobit models to examine the 3 cardiovascular biomarkers by hypertension status in the following subgroups: age ≥35 years and age <35 years, pre-pregnancy obesity (body mass index ≥35 kg/m2) and no obesity, preeclampsia and no preeclampsia, gestational diabetes mellitus and no gestational diabetes mellitus, high sodium (≥2300 mg/day) vs. low sodium, very low fruits/vegetables (<3 servings/day) vs. low or higher (>3 servings/day) fruits/vegetables. Interaction terms were used to compare effects across subgroups. Relative difference (%, with 95%-confidence intervals) presented (x-axis) as the difference between the group with hypertension vs. the group with no hypertension.
Figure 2.
Figure 2.
Geometric means (95% confidence intervals) of A) high-sensitivity cardiac troponin I (hs-cTnI) (ng/L), a marker of cardiac injury, B) N-terminal pro-B-type natriuretic peptide (NT-proBNP, pg/mL), a marker of cardiac strain, and C) high-sensitivity C-reactive protein (hs-CRP, mg/L), a marker of inflammation, during and after pregnancy by hypertension status (hypertension (HTN) = green, no HTN = blue) after adjustment for age and body mass index. P< 0.05 is marked by an asterix for each group when compared to baseline. Mean gestational age at baseline was 27.5 (SD 1.7) weeks, and additional labs drawn at the delivery admission and postpartum day 1. Values below the limit of detection were imputed as the lowest measured value (0.3 ng/L)/√2 for hs-cTnI, and as the detection limit (5 pg/mL)/√2 for NT-proBNP, (0.664 mg/L)/√2 for hs-CRP. There were 38 participants with HTN with 87 measurements and 38 participants without HTN with 84 measurements
See this image and copyright information in PMC

References

    1. Wang S, Rexrode KM, Florio AA, Rich-Edwards JW, Chavarro JE. Maternal Mortality in the United States: Trends and Opportunities for Prevention. Annu Rev Med. 2023; 74:199–216. < 10.1146/annurev-med-042921-123851>. - DOI - PubMed
    1. The California Pregnancy-Associated Mortality Review. Report from 2002–2007 Maternal Death Reviews. Sacramento: California Department of Public Health, Maternal, Child and Adolescent Health Division. 2017.
    1. GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Lond Engl. 2016; 388:1775–1812. < 10.1016/S0140-6736(16)31470-2>. - DOI - PMC - PubMed
    1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA, Deaton C, Simpson IA, Aboyans V, Agewall S, Barbato E, Calda P, Coca A, Coman IM, De Backer J, Delgado V, Di Salvo G, Fitzsimmons S, Fitzsimons D, Garbi M, Gevaert S, Hindricks G, Jondeau G, Kluin J, Lionis C, McDonagh TA, Meier P, Moons P, Pantazis A, Piepoli MF, Rocca B, Roffi M, Rosenkranz S, Sarkozy A, Shlyakhto E, Silversides CK, Sliwa K, Sousa-Uva M, Tamargo J, Thorne S, Van de Velde M, Williams B, Zamorano JL, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet J-P, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh TA, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Zamorano JL, Hammoudi N, Piruzyan A, Mascherbauer J, Samadov F, Prystrom A, Pasquet A, Caluk J, Gotcheva N, Skoric B, Heracleous H, Vejlstrup N, Maser M, Kaaja RJ, Srbinovska-Kostovska E, Mounier-Vehier C, Vakhtangadze T, Rybak K, Giannakoulas G, Kiss RG, Thrainsdottir IS, Erwin RJ, Porter A, Geraci G, Ibrahimi P, Lunegova O, Mintale I, Kadri Z, Benlamin H, Barysiene J, Banu CA, Caruana M, Gratii C, Haddour L, Bouma BJ, Estensen M-E, Hoffman P, Petris AO, Moiseeva O, Bertelli L, Tesic BV, Dubrava J, Koželj M, Prieto-Arévalo R, Furenäs E, Schwerzmann M, Mourali MS, Ozer N, Mitchenko O, Nelson-Piercy C. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018; 39:3165–3241. < 10.1093/eurheartj/ehy340>. - DOI - PubMed
    1. ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy. Obstet Gynecol. 2019; 133:e26–e50. < 10.1097/AOG.0000000000003020>. - DOI - PubMed