Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients
Authors:
Martin Magnussona; Stefan Jovingebc; Erik Rydberga; Bj
rn Dahl
fd; Christian Halle; Olav W. Nielsenf; Anders Grubbg; Ronnie Willenheimera
rn Dahl
fd; Christian Halle; Olav W. Nielsenf; Anders Grubbg; Ronnie Willenheimera
| Affiliations: | a Department of Cardiology, Malm University Hospital, Lund University, Malm , 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, stra Hospital, G teborg University, G teborg, 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
First Published:
August
2009
Subjects:
Hypertension;
Vascular Medicine;
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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.
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| Keywords: BNP; hypertension; natriuretic; Nt-BNP; Nt-ANP; remodeling |
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