Impact of systemic hypertension on the diagnostic performance of B-type natriuretic peptide in patients with acute dyspnea.
Hypertension may affect the diagnostic performance of B-type natriuretic peptide (BNP). The objective of the present study was to assess the impact of a history of hypertension or blood pressure elevation on admission on the diagnostic performance of BNP in the diagnosis of heart failure (HF) in patients with acute dyspnea. BNP levels were measured using a rapid point-of-care device in 1,586 patients with acute dyspnea. In patients with HF, BNP levels did not differ between those with and without histories of hypertension. Conversely, in patients without HF, a history of hypertension was associated with higher median BNP levels (38 pg/ml [interquartile range 13 to 119] vs 21 pg/ml [interquartile range 7 to 64], p <0.001). The areas under the receiver-operating characteristic curves were 0.88 and 0.93 for those with and without histories of hypertension, respectively (p <0.001). Blood pressure elevation on admission did not affect the diagnostic accuracy of BNP (areas under the curve 0.90 in the 2 groups). In conclusion, although a history of hypertension is associated with higher BNP levels in patients with acute dyspnea without HF, the impact on the overall diagnostic performance of BNP is modest. Accordingly, BNP performs well as an indicator of HF in patients presenting in emergency departments regardless of a history of hypertension or elevated blood pressure on admission.
Pahle
Andreas S
AS
Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Sørli
Daniel
D
Omland
Torbjørn
T
Knudsen
Cathrine Wold
CW
Westheim
Arne
A
Wu
Alan H B
AH
Steg
Philippe Gabriel
PG
McCord
James
J
Nowak
Richard M
RM
Hollander
Judd E
JE
Storrow
Alan B
AB
Abraham
William T
WT
McCullough
Peter A
PA
Maisel
Alan
A
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001795:Blood Pressure Determination; D015331:Cohort Studies; D016001:Confidence Intervals; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000378:metabolism; D011237:Predictive Value of Tests; D011336:Probability; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain