title: Relation of plasma midregional proatrial natriuretic peptide to target organ damage in adults with systemic hypertension.
abstract: We tested the hypothesis that, in adults with essential hypertension, plasma levels of midregional proatrial natriuretic peptide (MR-proANP) are associated with target organ damage. MR-proANP is a newly described stable fragment of N-terminal proatrial natriuretic peptide. Participants included 1,919 adults with hypertension identified from the community (1,037 African-Americans, 65 +/- 9 years of age, 72% women; 882 non-Hispanic whites, 61 +/- 9 years of age, 55% women). We measured MR-proANP by an immunoluminometric assay. Measurements of target organ damage included the ankle-brachial index (ABI), urinary albumin-creatinine ratio (UACR), and left ventricular (LV) mass (available only in African-Americans). Generalized estimating equations were used to assess whether plasma MR-proANP was associated with measurements of target organ damage, independent of potential confounding variables. In African-Americans, higher MR-proANP was significantly associated with lower ABI (p <0.0001), higher UACR (p <0.0001), and greater LV mass (indexed to height to the power of 2.7, p <0.0001). After adjustment for age, gender, body mass index, systolic blood pressure, estimated glomerular filtration rate, smoking history, diabetes mellitus, total and high-density lipoprotein cholesterols, medication (blood pressure lowering, statin, and aspirin) use, and previous myocardial infarction or stroke, higher MR-proANP levels remained significantly associated with lower ABI (p = 0.01), higher UACR (p = 0.0007), and greater LV mass index (p <0.0001). In non-Hispanic whites, higher MR-proANP levels were significantly associated with lower ABI (p = 0.002) and greater UACR (p = 0.001), but not after adjustment for the covariates listed earlier. In conclusion, plasma MR-proANP may be a marker of target organ damage in the setting of hypertension, especially in African-Americans.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mahyar
authors.initials: M
authors.lastname: Khaleghi
authors.forename: Malik A
authors.initials: MA
authors.lastname: Al-Omari
authors.forename: Venkateswarlu
authors.initials: V
authors.lastname: Kondragunta
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.forename: Iftikhar J
authors.initials: IJ
authors.lastname: Kullo
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology; D055109:Ankle Brachial Index; D009320:Atrial Natriuretic Factor / Q000097:blood* / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001795:Blood Pressure Determination; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000652:urine; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood* / Q000378:metabolism; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data
chemical_list: D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D009320:Atrial Natriuretic Factor; D003404:Creatinine