title: Amino-terminal-pro-B-type natriuretic peptide levels and low diastolic blood pressure: potential relevance to the diastolic J-curve.
abstract: BACKGROUND
  There is debate whether the J-curve relationship between cardiac event risk and DBP is because of inherent cardiac risk or is a consequence of blood pressure (BP) lowering therapy.
  
  
  METHODS
  We examined the association between the cardiovascular risk marker amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) and DBP in 1781 women and 2211 men aged at least 60 years with one or more cardiovascular risk factors; exclusion criteria were known heart failure or cardiac abnormality on a cardiac imaging study.
  
  
  RESULTS
  The lowest median serum NT-proBNP levels were for DBP 85-89 mmHg for both women and men. DBP less than 70 mmHg in women and less than 80 mmHg in men was associated with higher NT-proBNP levels than the levels at DBP 85-89 mmHg, and this relationship was present for those with SBP equal to or less than 140 and SBP greater than 140 mmHg. In conditional logistic regression models, the association of elevated NT-proBNP levels with low DBP in women was no longer statistically significant after adjustment for age, ischaemic heart disease (IHD), pulse rate, atrial fibrillation, haemoglobin and glomerular filtration rate, whereas the association in men was no longer statistically significant after adjustment for age and IHD. By contrast, the association between elevated NT-proBNP levels and low DBP remained statistically significant after adjustment for the number of antihypertensive drug classes alone or together with all antihypertensive drugs, including β-blocker therapy.
  
  
  CONCLUSIONS
  There was a J-curve relationship between the cardiovascular risk marker NT-proBNP and DBP that was explained by the clinical variables and not by the BP-lowering therapy.
authors.affiliation: aSt. Vincent's Institute of Medical Research bDepartment of Medicine, University of Melbourne cCentre of Cardiovascular Research and Education in Therapeutics, Monash University dDepartment of Cardiology, St. Vincent's Hospital, Melbourne, Victoria eSchool of Medicine, University of Adelaide, Adelaide, South Australia fDepartment of Clinical Epidemiology, University of Melbourne gDepartment of Preventive Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Campbell
authors.forename: Michele
authors.initials: M
authors.lastname: McGrady
authors.forename: David L
authors.initials: DL
authors.lastname: Prior
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Coller
authors.forename: Umberto
authors.initials: U
authors.lastname: Boffa
authors.forename: Louise
authors.initials: L
authors.lastname: Shiel
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D003971:Diastole; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain