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Cardiovascular and Renal Surrogate Markers in the Clinical Management of Hypertension

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Abstract

Introduction

Surrogate markers represent a significant contribution to early diagnosis, longitudinal prognoses, and outcome prediction in cases of hypertension. They often enable detection of disease and disease potential when the disease is still subclinical and are useful noninvasive tools for designing and evaluating therapeutic programs. Surrogate markers are increasingly employed as predictive endpoints for treatment.

Methods

Key studies supporting the importance of surrogate markers as diagnostic and prognostic predictors of cardiovascular and renal clinical outcomes in hypertension, as well as what is known about the effects of renin-angiotensin-aldosterone system-blocking agents on these biomarkers were reviewed.

Results

Clinical data supporting the use of surrogate markers for heart failure, such as brain natriuretic peptide (BNP) and N-terminal prohormone BNP; markers for renal function, such as urinary albumin to creatinine ratio (UACR), urinary albumin excretion rates (UAER), and creatinine, reflecting glomerular filtration; and markers of cardiac remodeling, such as left ventricular hypertrophy and calculations of left ventricular mass index (LVMI), were reviewed for their utility in improving prognosis and treatment efficacy. Finally, hypertension treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially direct renin inhibitors can significantly improve outcomes predicted by surrogate markers.

Conclusions

BNP, UACR, UAER, and LVMI, among others, have been increasingly established as valid surrogate markers with significant value for hypertension prognosis and therapy. The benefits of using surrogate markers to gauge the effectiveness of hypertension therapy in reducing renal and cardiac complications can be seen in improved morbidity and mortality.

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Acknowledgments/Disclosures

Sponsorship role

This review article was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. Novartis contributed to the identification of subject matter expert to author this manuscript and was provided the opportunity to discuss included content and review data for factual correctness and consistency.

Dr. Maisel received a modest honorarium from Novartis and editorial assistance from Complete Healthcare Communications, Inc. (CHC).

The opinions expressed in the review article are those of the author and do not necessarily represent the views of the journal, author’s institutions, CHC, or Novartis, unless otherwise specified.

Disclosure of off-label use

This review article may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. Authors have been asked to disclose any off-label (unapproved) use of products mentioned in this article. If an off-label use is mentioned, each author is responsible for identifying the drug and its off-label indication. CHC, and Novartis do not recommend the use of any agent outside of the labeled indications. Please refer to the full prescribing information for each product for discussion of approved indications, contraindications, and warnings.

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  1. Coronary Care Unit and Heart Failure Program, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, Cardiology Section, mc 9111A, San Diego, CA, 92161, USA

    Alan S. Maisel

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Maisel, A.S. Cardiovascular and Renal Surrogate Markers in the Clinical Management of Hypertension. Cardiovasc Drugs Ther 23, 317–326 (2009). https://doi.org/10.1007/s10557-009-6177-4

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