Differential effects of brachial and central blood pressures on circulating levels of high-sensitivity cardiac troponin I in the general population


      • This study investigates the effect of brachial and central BP on serum concentrations of hs-cTnI.
      • Serum concentrations of hs-cTnI increase with increasing brachial and central BP.
      • In subjects with increased arterial stiffness, the effect of central BP on serum concentrations of hs-cTnI was greater.
      • These associations remained significant after further adjustment for BNP and/or oxidative marker.
      • Central BP may have a strong effect on silent myocardial damage.


      Background and aims

      Severe cardiac load increases circulating concentrations of high-sensitivity cardiac troponin I (hs-cTnI) through non-ischemic mechanisms. The present study was designed to investigate the effect of central blood pressure (BP), which reflects cardiac load rather than peripheral BP, on serum concentrations of hs-cTnI in subjects with or without increased arterial stiffness.


      We enrolled 1210 participants taking part in a yearly health checkup program. Laboratory measurements included serum concentrations of hs-cTnI and derivative reactive oxygen metabolites (d-ROM), as well as plasma concentrations of B-type natriuretic peptide (BNP). Central BP and the radial augmentation index (rAI) were evaluated non-invasively using an automated device.


      Univariate and multivariable regression analysis showed that both brachial and central BP were significantly associated with hs-cTnI. When subjects were divided into two groups according to the mean rAI value, those with higher rAI had higher hs-cTnI concentrations than those with lower rAI. In subgroup analyses, in those with lower rAI, brachial but not central systolic BP was independently associated with hs-cTnI, whereas in those with higher rAI, central but not brachial systolic BP was independently associated with hs-cTnI. These associations remained significant after further adjustment for BNP and/or d-ROM concentrations.


      Circulating levels of hs-cTnI increase with increasing brachial and central BP, but the effect of central BP was greater in subjects with higher rAI. This indicates that central BP may have a strong effect on silent myocardial damage, assessed as increased circulating hs-cTnI, particularly in subjects with increased arterial stiffness.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Heidenreich P.A.
        • Alloggiamento T.
        • Melsop K.
        • McDonald K.M.
        • Go A.S.
        • et al.
        The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis.
        J. Am. Coll. Cardiol. 2001; 38: 478-485
        • Reichlin T.
        • Hochholzer W.
        • Bassetti S.
        • Steuer S.
        • Stelzig C.
        • et al.
        Early diagnosis of myocardial infarction with sensitive cardiac troponin assays.
        N. Engl. J. Med. 2009; 361: 858-867
        • Reiter M.
        • Twerenbold R.
        • Reichlin T.
        • Benz B.
        • Haaf P.
        • et al.
        Early diagnosis of acute myocardial infarction in patients with pre-existing coronary artery disease using more sensitive cardiac troponin assays.
        Eur. Heart J. 2012; 33: 988-997
        • Carlton E.
        • Greenslade J.
        • Cullen L.
        • Body R.
        • Than M.
        • et al.
        Evaluation of high-sensitivity cardiac troponin I levels in patients with suspected acute coronary syndrome.
        JAMA Cardiol. 2016; 1: 405-412
        • Horwich T.B.
        • Patel J.
        • MacLellan W.R.
        • Fonarow G.C.
        Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure.
        Circulation. 2003; 108: 833-838
        • deFilippi C.R.
        • de Lemos J.A.
        • Christenson R.H.
        • Gottdiener J.S.
        • Kop W.J.
        • et al.
        Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults.
        JAMA. 2010; 304: 2494-2502
        • Goto T.
        • Takase H.
        • Toriyama T.
        • Sugiura T.
        • Sato K.
        • et al.
        Circulating concentrations of cardiac proteins indicate the severity of congestive heart failure.
        Heart. 2003; 89: 1303-1307
        • Seliger S.L.
        • Hong S.N.
        • Christenson R.H.
        • Kronmal R.
        • Daniels L.B.
        • et al.
        High-sensitive cardiac troponin T as an early biochemical signature for clinical and subclinical heart failure: MESA (Multi-Ethnic Study of Atherosclerosis).
        Circulation. 2017; 135: 1494-1505
        • Bossard M.
        • Thériault S.
        • Aeschbacher S.
        • Schoen T.
        • Kunz S.
        • et al.
        Factors independently associated with cardiac troponin I levels in young and healthy adults from the general population.
        Clin. Res. Cardiol. 2017; 106: 96-104
        • Cavender M.A.
        • White W.B.
        • Jarolim P.
        • Bakris G.L.
        • Cushman W.C.
        • et al.
        Serial measurement of high sensitivity troponin I and cardiovascular outcomes in patients with type 2 diabetes mellitus in the EXAMINE Trial.
        Circulation. 2017; 16: 1911-1921
        • Nichols W.W.
        Clinical measurement of arterial stiffness obtained from noninvasive pressure waveforms.
        Am. J. Hypertens. 2005; 18: 3S-10S
        • Roman M.J.
        • Okin P.M.
        • Kizer J.R.
        • Lee E.T.
        • Howard B.V.
        • et al.
        Relations of central and brachial blood pressure to left ventricular hypertrophy and geometry: the strong heart study.
        J. Hypertens. 2010; 28: 384-388
        • Takazawa K.
        • Kobayashi H.
        • Shindo N.
        • Tanaka N.
        • Yamashina A.
        Relationship between radial and central arterial pulse wave and evaluation of central aortic pressure using the radial arterial pulse wave.
        Hypertens. Res. 2007; 30: 219-228
        • Takase H.
        • Dohi Y.
        • Kimura G.
        Distribution of central blood pressure values estimated by Omron HEM-9000AI in the Japanese general population.
        Hypertens. Res. 2013; 36: 50-57
        • Nichols W.W.
        • Denardo S.J.
        • Wilkinson I.B.
        • McEniery C.M.
        • Cockcroft J.
        • et al.
        Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform.
        J. Clin. Hypertens. 2008; 10: 295-303
        • Millasseau S.C.
        • Patel S.J.
        • Redwood S.R.
        • Ritter J.M.
        • Chowienczyk P.J.
        Pressure wave reflection assessed from the peripheral pulse: is a transfer function necessary?.
        Hypertension. 2003; 41: 1016-1020
        • Qureshi G.
        • Brown R.
        • Salciccioli L.
        • Qureshi M.
        • Rizvi S.
        • et al.
        Relationship between aortic atherosclerosis and non-invasive measures of arterial stiffness.
        Atherosclerosis. 2007; 195: e190-e194
        • Rosenbaum D.
        • Giral P.
        • Chapman J.
        • Rached F.H.
        • Kahn J.F.
        • et al.
        Radial augmentation index is a surrogate marker of atherosclerotic burden in a primary prevention cohort.
        Atherosclerosis. 2013; 231: 436-441
        • Sugiura T.
        • Dohi Y.
        • Takase H.
        • Fujii S.
        • Ohte N.
        Oxidative stress is closely associated with increased arterial stiffness, especially in aged male smokers without previous cardiovascular events: a cross-sectional study.
        J. Atherosclerosis Thromb. 2017; 24: 1186-1198
        • Wang K.L.
        • Cheng H.M.
        • Chuang S.Y.
        • Spurgeon H.A.
        • Ting C.T.
        • et al.
        Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality?.
        J. Hypertens. 2009; 27: 461-467
        • Williams B.
        • Lacy P.S.
        • Thom S.M.
        • Cruickshank K.
        • Stanton A.
        • et al.
        CAFE investigators; Anglo-Scandinavian cardiac outcomes trial investigators; CAFE steering committee and writing committee. Differential impact of BP-lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study.
        Circulation. 2006; 113: 1213-1225
        • Yamashita S.
        • Dohi Y.
        • Takase H.
        • Sugiura T.
        • Ohte N.
        Central blood pressure reflects left ventricular load, while brachial blood pressure reflects arterial damage.
        Blood Pres. 2014; 23: 356-362
        • Tanaka S.
        • Sugiura T.
        • Yamashita S.
        • Dohi Y.
        • Kimura G.
        • et al.
        Differential response of central blood pressure to isometric and isotonic exercises.
        Sci. Rep. 2014; 43884
        • Shimamoto K.
        • Ando K.
        • Fujita T.
        • Hasebe N.
        • Higaki J.
        • et al.
        Japanese Society of hypertension committee for guidelines for the management of hypertension. The Japanese Society of hypertension guidelines for the management of hypertension (JSH 2014).
        Hypertens. Res. 2014; 37: 253-392
        • Teramoto T.
        • Sasaki J.
        • Ueshima H.
        • Egusa G.
        • Kinoshita M.
        • et al.
        Japan Atherosclerosis Society (JAS) Committee for Epidemiology and Clinical Management of Atherosclerosis. Diagnostic criteria for dyslipidemia. Executive summary of Japan Atherosclerosis Society (JAS) guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese.
        J. Atherosclerosis Thromb. 2007; 14: 155-158
        • Seino Y.
        • Nanjo K.
        • Tajima N.
        • Kadowaki T.
        • Kashiwagi A.
        • et al.
        • Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus
        Report of the committee on the classification and diagnostic criteria of diabetes mellitus.
        J Diabetes Investig. 2010; 1: 212-228
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • Zhang Y.L.
        • Castro 3rd, A.F.
        • et al.
        CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate.
        Ann. Intern. Med. 2009; 150: 604-612
        • Sugiura T.
        • Dohi Y.
        • Takase H.
        • Yamashita S.
        • Tanaka S.
        • et al.
        Increased reactive oxygen metabolites is associated with cardiovascular risk factors and vascular endothelial damage in middle-aged Japanese subjects.
        Vasc. Health Risk Manag. 2011; 7: 475-482
        • Sugiura T.
        • Takase H.
        • Toriyama T.
        • Goto T.
        • Ueda R.
        • et al.
        Circulating levels of myocardial proteins predict future deterioration of congestive heart failure.
        J. Card. Fail. 2005; 11: 504-509
        • Everett B.M.
        • Zeller T.
        • Glynn R.J.
        • Ridker P.M.
        • Blankenberg S.
        High-sensitivity cardiac troponin I and B-type natriuretic peptide as predictors of vascular events in primary prevention: impact of statin therapy.
        Circulation. 2015; 131: 1851-1860
        • Kotani K.
        • Koibuchi H.
        • Miyamoto M.
        • Yamada T.
        • Taniguchi N.
        Relationship between reactive oxygen metabolites and carotid intima–media thickness in subjects with hypercholesterolemia.
        Med. Princ. Pract. 2010; 19: 496-498
        • Patel R.S.
        • Al Mheid I.
        • Morris A.A.
        • Ahmed Y.
        • Kavtaradze N.
        • et al.
        Oxidative stress is associated with impaired arterial elasticity.
        Atherosclerosis. 2011; 218: 90-95
        • Sugiura T.
        • Dohi Y.
        • Yamashita S.
        • Yamamoto K.
        • Tanaka S.
        • et al.
        Malondialdehyde-modified LDL to HDL-cholesterol ratio reflects endothelial damage.
        Int. J. Cardiol. 2011; 147: 461-463
        • Sugiura T.
        • Dohi Y.
        • Yamashita S.
        • Hirowatari Y.
        • Fujii S.
        • et al.
        Serotonin in peripheral blood reflects oxidative stress and plays a crucial role in atherosclerosis: novel insights toward holistic anti-atherothrombotic strategy.
        Atherosclerosis. 2016; 246: 157-160
        • Lyngbakken M.N.
        • Skranes J.B.
        • de Lemos J.A.
        • Nygård S.
        • Dalen H.
        • et al.
        Impact of smoking on circulating cardiac troponin I concentrations and cardiovascular events in the general population: the HUNT Study (Nord-Trøndelag Health Study).
        Circulation. 2016; 134: 1962-1972