title: The limited value of plasma B-type natriuretic peptide for screening for left ventricular hypertrophy among hypertensive patients.
abstract: BACKGROUND
  Several reports have suggested that plasma B-type natriuretic peptide (BNP) levels are elevated in hypertensive patients especially with left ventricular (LV) hypertrophy. However, few data have been available concerning the utility of plasma BNP measurement to identify LV hypertrophy in hypertensive patients in a general population screening context.
  
  
  METHODS
  We measured plasma BNP concentrations in 1112 volunteers in a health screening program (mean age, 57 years). All subjects underwent electrocardiography, chest X-ray, and echocardiography. Among the sample, 284 subjects were designated as hypertensive because they were on antihypertensive drugs or showed elevated systemic blood pressure. By echocardiography, 36 of the hypertensive patients showed significant LV hypertrophy.
  
  
  RESULTS
  There were no significant differences in age and sex between the LV hypertrophy and non-LV hypertrophy groups. Plasma BNP levels in the LV hypertrophy group were significantly higher than in the non-LV hypertrophy group (19.4 +/- 18.9 v 28.2 +/- 28.2 pg/mL; P <.05). However, the ability of plasma BNP levels to discriminate between LV hypertrophy and non-LV hypertrophy patients was not sufficient as the area under the receiver operating characteristic curve was 0.588 (95% CI: 0.528-0.646) with sensitivity of 50.0% and specificity of 69.0%. Positive and negative predictive values for detecting LV hypertrophy among hypertensive patients were 18.9% and 90.5%, respectively. This ability did not improve significantly when the screening was limited to patients with untreated LV hypertrophy or concentric LV hypertrophy.
  
  
  CONCLUSIONS
  Plasma BNP testing in a mass screening setting is of limited use for the identification of LV hypertrophy patients among hypertensive patients with heterogeneous etiology.
authors.affiliation: Second Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan. nkmrmoto@iwate-med.ac.jp
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.forename: Shinetsu
authors.initials: S
authors.lastname: Yonezawa
authors.forename: Kenyu
authors.initials: K
authors.lastname: Satou
authors.forename: Masahide
authors.initials: M
authors.lastname: Nagano
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Hiramori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D020097:Natriuretic Peptide, Brain