Background: Most patients with hypertension exhibit elevated and detectable levels of natriuretic peptides, particularly BNP and NT-proBNP, as well as troponin concentrations. However, the prognostic relevance of this finding has not been clearly established in patients who have hypertension without heart failure (HF). In this review, we aimed to evaluate the prognostic utility of BNP/NT-proBNP alongside troponin T/I for risk stratification in hypertensive patients, excluding those with HF. Methods: This systematic review was registered in PROSPERO (CRD42024552031). A systematic literature search was conducted using two online databases, Ovid Medline and Web of Science, to identify studies. Data retrieved from articles were used in line with the PRISMA statement guidelines. Participants were aged ≥ 18 years with hypertension. The primary end point was a major adverse cardiac event (MACE) and its individual components. Descriptive synthesis was performed, and data are presented in tabular form. Results: Seventeen studies (70,021 participants) were retrieved for analysis comprising eight prospective cohort studies, six randomized controlled trials, and three retrospective studies. The review evaluated cardiac biomarkers: BNP (n = 6), NT proBNP (n=9), troponin T (n = 4), and troponin I (n = 7). Studies predicted composite MACE (n = 8), all-cause mortality (n = 7), HF (n = 6), and atrial fibrillation (n = 3) outcomes. Cardiac biomarkers showed a strong association with reported outcomes. However, heterogeneity in biomarker thresholds and methodologies limited comparability. Conclusions: The obtained results suggest that elevated cardiac biomarkers BNP/NT-proBNP and troponin I are associated with significantly higher risk of MACE and are powerful predictors in clinical setting. However, large-scale studies are required to validate the robustness and prognostic utility of these biomarkers

The use of biomarkers in heart failure (HF) is long established; however, little is known about the prognostic significance of these biomarkers in hypertension when HF has been excluded. This study examined the prognostic significance of routine cardiac biomarkers (natriuretic peptides and cardiac troponins) in hypertensive patients when HF has been excluded. We analyzed electronic medical records from a global federated research network TriNetX. Cohorts were built based on biomarker-specific thresholds with 1:1 propensity-score matching. Cox proportional models were used to estimate hazard ratios with 95% confidence interval for 5-year incident major adverse cardiac events (MACE). Our analysis identified four biomarker cohorts: (a) B-type natriuretic peptide (BNP)-80,740 patients (b) N-terminal pro B-type natriuretic peptide (NT-proBNP)-46,164 patients (c) cardiac troponin T-13,785 patients, and (d) cardiac troponin I-183,346. Elevated NT-proBNP had an increased risk for MACE (HR 1.9, 95% CI 1.86, 1.96 p < 0.0001) and all-cause mortality (HR 2.13 95% CI 95% CI 2.07, 2.18 p < 0.0001) compared to those with lower levels. Similarly, hs-cTnT showed significant association with MACE (HR 1.53 95% CI 1.46, 1.61 p < 0.0001). Elevated natriuretic peptides and cardiac troponins in hypertensive patients without HF demonstrate significant risk of MACE and its individual components.