Predictors of Biomarker Dynamics in Cardiometabolic Phenotypes Associated With Arterial Hypertension, Type Two Diabetes, and Obesity

Objective: To assess the prognostic significance of changes in circulating biomarkers related to neurohumoral activation, myocardial remodeling, metabolic regulation, and renal function in patients with arterial hypertension complicated by type two diabetes and obesity, and to identify clinical and functional predictors associated with the formation of a favorable cardiometabolic phenotype during targeted pharmacological treatment. Design and method: A total of 211 patients with arterial hypertension were enrolled and stratified into four clinical groups according to the presence of type two diabetes and obesity. Serum levels of catestatin, cardiotrophin one, beta two microglobulin, cystatin C, neutrophil gelatinase associated lipocalin, N terminal prohormone of brain natriuretic peptide, leptin, and insulin were measured using immunoassay methods. Comprehensive evaluation included echocardiographic assessment of cardiac structure and function, lipid profile, glycemic control, renal function parameters, and body mass index. Multivariate regression and logistic analyses were applied to identify independent predictors of biomarker dynamics and cardiometabolic phenotypes. Results: Changes in biomarker levels demonstrated significant associations with structural and functional cardiac parameters, renal function, lipid metabolism, and glycemic control. Catestatin and cardiotrophin one were predominantly associated with favorable myocardial remodeling and improved diastolic function in isolated arterial hypertension. In patients with metabolic comorbidity, cystatin C, beta two microglobulin, neutrophil gelatinase associated lipocalin, leptin, and N terminal prohormone of brain natriuretic peptide showed strong correlations with left ventricular hypertrophy, dyslipidemia, impaired renal function, and subclinical cardiac dysfunction. The most consistent predictive value across cardiometabolic phenotypes was observed for catestatin, cardiotrophin one, cystatin C, beta two microglobulin, leptin, and N terminal prohormone of brain natriuretic peptide. Conclusions: A multibiomarker approach provides significant prognostic information beyond traditional clinical parameters in arterial hypertension complicated by metabolic disorders. Specific biomarker patterns reflect distinct cardiometabolic phenotypes and are associated with myocardial remodeling, diastolic dysfunction, renal impairment, and metabolic imbalance. Integration of biomarker monitoring into routine clinical practice may improve risk stratification and support personalized therapeutic strategies in patients with arterial hypertension and metabolic comorbidity.