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Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients 

Authors: Martin Magnussona; Stefan Jovingebc; Erik Rydberga; Bjoumlrn Dahloumlfd; Christian Halle; Olav W. Nielsenf; Anders Grubbg; Ronnie Willenheimera
Affiliations:   a Department of Cardiology, Malmouml University Hospital, Lund University, Malmouml, Sweden
b Lund Strategic Research Center for Stem Cell Biology and Cell Therapy, Lund University, Lund, Sweden
c Department of Cardiology, Lund University Hospital, Lund University, Lund, Sweden
d Department of Medicine, Oumlstra Hospital, Goumlteborg University, Goumlteborg, Sweden
e Medical and Faculty Division, Akershus University Hospital, University of Oslo, Norway
f Department of Cardiology Rigshospitalet, Copenhagen, Denmark
g Department of Clinical Chemistry, University Hospital in Lund, Lund University, Lund, Sweden
DOI: 10.1080/08037050903083298
Publication Frequency: 6 issues per year
Published in: journal Blood Pressure, Volume 18, Issue 4 August 2009 , pages 196 - 203
First Published: August 2009
Formats available: HTML (English) : PDF (English)
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Abstract

Aims. This study was performed to evaluate the relationship between three different natriuretic peptides and left ventricular mass, function and diameter, and kidney function in patients with hypertension. Methods. One hundred and thirty-nine patients with moderate hypertension were consecutively included. N-terminal brain natriuretic peptide (Nt-BNP), brain natriuretic peptide (BNP) and N-terminal pro-atrial natriuretic peptide (Nt-ANP) were analyzed. Cardiac remodeling was assessed by echocardiography (UCG) and glomerular filtration was estimated by cystatin C. Results. Patients were stratified into four groups with regard to the extent of cardiac remodeling: (1) no remodeling; (2) one of left ventricular hypertrophy, left ventricular dysfunction or left ventricular dilatation; (3) two of above and (4) all three parameters. All peptides differed significantly between the groups (all p<0.001), with a continuous stepwise increase from groups 1 through 4. Receiver operating characteristic analysis showed equal diagnostic performances for the detection of any cardiac abnormalities for Nt-BNP [area under curve, AUC=0.63 (0.52-0.75), p=0.026] and BNP [AUC=0.64 (0.53-0.76), p=0.019], both, however superior to Nt-ANP [AUC=0.59 (0.47-0.70), p=0.139]. In multivariable linear regression analysis, all three indicators of cardiac remodeling were independently correlated with ln Nt-BNP and ln BNP, whereas only left ventricular diameter was independently correlated with ln Nt-ANP. Conclusions. Natriuretic peptide levels increased with increasing number of markers of cardiac remodeling. Nt-BNP and BNP are useful to discriminate between patients with regard to cardiac remodeling and might be considered a screening tool in order select patients eligible for further examination with UCG examination.
Keywords: BNP; hypertension; natriuretic; Nt-BNP; Nt-ANP; remodeling
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