From the Research
For patients with troponin elevation, the recommended blood pressure goal is generally below 130/80 mmHg, as intensive blood pressure lowering has been shown to reduce cardiovascular disease risk and all-cause death, even in individuals with low diastolic blood pressure and elevated troponin levels 1. To achieve this goal, a combination of lifestyle modifications and antihypertensive medications is typically necessary.
- First-line medications often include angiotensin-converting enzyme (ACE) inhibitors like ramipril (2.5-10 mg daily) or lisinopril (10-40 mg daily), or angiotensin receptor blockers (ARBs) such as losartan (25-100 mg daily) or candesartan (8-32 mg daily).
- Thiazide diuretics like hydrochlorothiazide (12.5-25 mg daily) are frequently added as a second agent.
- Calcium channel blockers like amlodipine (5-10 mg daily) may also be beneficial, particularly in older patients. Blood pressure should be monitored regularly, initially every 2-4 weeks until the target is reached, then every 3-6 months thereafter. Aggressive blood pressure control is particularly important in the first few months after a cardiovascular event when the risk of recurrence is highest. However, the effect of intensive blood pressure lowering on troponin levels is complex, with a study showing a 3% increase in hs-cTnT levels over 1-year follow-up, which was mediated by the effect of blood pressure lowering on reduced kidney filtration 2. In contrast, intensive blood pressure lowering led to a 10% decrease in NT-proBNP, a finding that was explained by the decrease in blood pressure 2. Overall, the benefits of intensive blood pressure lowering in reducing cardiovascular disease risk and all-cause death outweigh the potential risks, and blood pressure should be aggressively controlled to a target of less than 130/80 mmHg in patients with troponin elevation.