Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients.
OBJECTIVE
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.
Magnusson
Martin
M
Department of Cardiology, Malmö University Hospital, Lund University, Malmö, Sweden. martin.magnusson@med.lu.se
Jovinge
Stefan
S
Rydberg
Erik
E
Dahlöf
Björn
B
Hall
Christian
C
Nielsen
Olav W
OW
Grubb
Anders
A
Willenheimer
Ronnie
R
D000368:Aged; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging; D008297:Male; D045265:Natriuretic Peptides / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging; D020257:Ventricular Remodeling / Q000502:physiology*
D045265:Natriuretic Peptides