title: Brain natriuretic peptide as an integrator of cardiovascular stiffening in hypertension.
abstract: BACKGROUND
  Left ventricular (LV) diastolic dysfunction and impairment of aortic elastic properties represent common sequelae of hypertension. We investigated the relationships of these cardiovascular adaptations with brain natriuretic peptide (BNP) levels in newly-diagnosed hypertension.
  
  
  METHODS
  200 consecutive hypertensives without LV hypertrophy (aged 52 years, 134 males, office BP=151.4/95.5 mmHg) underwent 24 hour ambulatory BP measurement as well as aortic stiffness and LV diastolic function assessment by means of carotid-femoral pulse wave velocity (c-f PWV) measurement and Tissue Doppler Imaging (TDI), respectively. Based on BNP values patients were classified into tertiles.
  
  
  RESULTS
  Hypertensives in the highest, compared to those in the lowest BNP tertile had significantly higher 24 h pulse pressure (by 6.2 mmHg, p=0.002), lower 24 h diastolic BP (by 5.7 mmHg, p=0.014), decreased Em/Am ratio (by 0.09, p=0.048) and increased c-f PWV (by 0.7 m/s, p=0.042). Moreover, hypertensives in the highest, compared with those in the lowest and the medium tertile of BNP, exhibited significantly lower Em (by 1.2 cm/s, p=0.001 and 1 cm/s, p=0.004, respectively) and higher E/Em ratio (by 1.3, p=0.018 and 1.3, p=0.014, respectively). BNP was significantly associated with E/Em ratio, 24 h pulse pressure and c-f PWV independently from age.
  
  
  CONCLUSIONS
  In hypertensives plasma BNP levels are associated not only with LV diastolic dysfunction but also with aortic stiffening. These findings suggest that BNP even within normal range constitutes a surrogate for cardiovascular functional impairment in the setting of essential hypertension without LV hypertrophy.
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Chatzis
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Efstathios
authors.initials: E
authors.lastname: Taxiarchou
authors.forename: Spyros
authors.initials: S
authors.lastname: Lalos
authors.forename: Zenon
authors.initials: Z
authors.lastname: Kyriakides
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kallikazaros
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002339:Carotid Arteries / Q000502:physiology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000473:pathology*; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011673:Pulsatile Flow / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain