Adults with high blood pressure along with prediabetes plus myocardial injury or stress are significantly more risk for developing heart failure (HF), a new post hoc analysis shows. Arnaud D. Kaze, MD, MPH, from the Banner-University Medical Center Phoenix, and colleagues, reported the corresponding data in a manuscript published online Wednesday in JAMA Cardiology. People with hypertension are more likely to develop HF, but little is known about how the comorbidities of prediabetes along with myocardial injury or stress can influence the pathogenesis of HF. Investigators in this prospective cohort study used data from the Systolic Blood Pressure Intervention Trial (SPRINT) to examine adults with hypertension and prediabetes (fasting blood plasma glucose=100-125 mg/dL) and see how these are associated with HF independently. They also looked at subclinical myocardial injury (high-sensitivity cardiac troponin [hs-cTnl]≥6 ng/L for men, 4 ng/L for women) or stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP]≥125 pg/mL). If the biomarker numbers went up by more than 25% from baseline to 12 months, these were considered longitudinal changes. Analysis took place between January 1 and May 31, 2025. The confirmed incident of HF was the primary outcome in this trial. A total of 8,234 patients (mean age=68 years, 37.1% women; 58.4% White, 28.7% Black; 11.0% Hispanic) were included in this analysis. Of these patients, 3,271 had prediabetes, 2,942 had subclinical myocardial injury and 3,593 had subclinical myocardial stress. Other comorbidities included current smoker status (12.8%) and daily alcohol consumption (14.7%). Regular exercise was present in 13.7% of patients. The median follow-up for patients was 2.3 years, and during this time 122 patients developed HF. Patients who had prediabetes and injury had higher risk for HF (hazard ratio [HR]=4.20, 95% confidence interval [CI]=2.31-7.63) compared with patients who had normal glucose levels and no myocardial injury. Results were similar in patients who had simultaneous myocardial stress (HR=5.20, 95% CI=2.52-10.70). Longitudinally, patients who had prediabetes plus a 25% or greater increase in hs-cTnl or NT-proBNP levels saw the most risk for HF (hs-cTnl: HR=3.05, 95% CI=1.58-5.88; NT-proBNP: HR=2.39, 95% CI=1.28-4.46). The authors noted a couple of limitations, including the observational nature of the study and lack of echocardiographic data. The large-scale analyses and extensive study of a high-risk population were strengths in this trial. Overall, patients with hypertension and additional cardiovascular disease risk factors of prediabetes and myocardial stress or injury are at higher risk for HF compared with those who only have high blood pressure. “These findings support a precision prevention approach that integrates cardiac biomarker trajectories with glycemic status to improve HF risk stratification for adults with hypertension,” the investigators concluded. Source: Kaze AD, Juraschek SP, Cohen JP, et al. Prediabetes, subclinical myocardial injury or stress, and heart failure risk for adults with hypertension. JAMA Cardiol. 2026 January 14 (Article in Press). Image Credit: thanksforbuying – stock.adobe.com