title: N-terminal prob-type natriuretic peptide is a marker of vascular remodelling and subclinical atherosclerosis in asymptomatic hypertensives.
abstract: BACKGROUND
  Arterial hypertension is a main determinant of arterial remodelling and atherosclerosis. Coronary artery calcium score and carotid intima-media thickness are recognized indices of vascular remodelling. Established biohumoral markers for the diagnosis of atherosclerosis are still lacking in asymptomatic subjects with hypertension.
  
  
  OBJECTIVE
  We aimed to test the association of plasma N-terminal pro B-type natriuretic peptide concentrations with either coronary artery calcium score or carotid intima-media thickness in asymptomatic hypertensive subjects.
  
  
  METHODS
  We conducted a case-control study on 436 hypertensi.ve and 436 age/sex-matched normotensive subjects from the population of the Montignoso HEart and Lung Project, a community-based study of asymptomatic general population ≥45 years. Subjects underwent N-terminal pro B-type natriuretic peptide measurement, echocardiography and evaluation of coronary artery calcium score and carotid intima-media thickness.
  
  
  RESULTS
  Hypertensive subjects had higher median coronary artery calcium score (60 (interquartile range, 30-112) vs. 15 (interquartile range 3-70) Agatson units, p = 0.007), carotid intima-media thickness (8.6 (interquartile range 7.5-9.1) vs. 7.9 (7.1-8.4) µm, p < 0.001) and indexed left ventricular mass (101 (interquartile range 82-126) vs. 87 (63-91) mg/m2, p = 0.03) than controls, with no differences in left ventricular ejection fraction, diameters, E/E', left atrial area. N-terminal pro B-type natriuretic peptide concentrations were higher in hypertensive subjects with either coronary artery calcium score (p = 0.008) or carotid intima-media thickness >75th (p < 0.006) percentile and highest in combined coronary artery calcium score/carotid intima-media thickness >75th percentile (p = 0.021). In multivariable analysis, N-terminal pro B-type natriuretic peptide independently predicted either coronary artery calcium score or carotid intima-media thickness >75th percentile, but only in hypertensive subjects (odds ratio = 1.87, 95% confidence interval 1.30-2.74, p = 0.001 and odds ratio = 1.99, 95% confidence interval 1.43-2.76, p = 0.001).
  
  
  CONCLUSIONS
  In asymptomatic subjects with hypertension, N-terminal pro B-type natriuretic peptide is a marker of hypertension-mediated preclinical vascular disease.
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy pastormerlo@ftgm.it.
authors: Luigi E
authors: LE
authors: Pastormerlo
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Stefano
authors: S
authors: Maffei
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Daniele Della
authors: DD
authors: Latta
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Vladislav
authors: V
authors: Chubuchny
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Carla
authors: C
authors: Susini
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Sergio
authors: S
authors: Berti
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Aldo
authors: A
authors: Clerico
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Concetta
authors: C
authors: Prontera
authors: Scuola Superiore Sant'Anna, Italy.
authors: Claudio
authors: C
authors: Passino
authors: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, USA.
authors: James L
authors: JL
authors: Januzzi
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Michele
authors: M
authors: Emdin
authors: Fondazione G. Monasterio CNR-Regione Toscana Pisa-Massa, Italy.
authors: Dante
authors: D
authors: Chiappino
mesh_terms: D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D018608:Ultrasonography, Doppler; D061205:Vascular Calcification / Q000000981:diagnostic imaging; D066253:Vascular Remodeling / Q000502:physiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Arterial hypertension; natriuretic peptide; subclinical atherosclerosis