title: Prognostic role of N-terminal pro-brain natriuretic peptide in asymptomatic hypertensive and diabetic patients in primary care: impact of age and gender : Results from the PROBE-HF study.
abstract: BACKGROUND
  The association between natriuretic peptides and clinical outcome in asymptomatic hypertensive and diabetic patients with no clinical evidence of heart failure (HF) is still unclear. We assessed the prognostic value of NT-pro BNP, and its interactions with age and gender, in a cohort of asymptomatic, stage A/B HF hypertensive and diabetic patients enrolled in primary care.
  
  
  METHODS
  NT-proBNP was measured in 1012 asymptomatic subjects with systemic hypertension and/or type-2 diabetes (age 66.6 ± 7.8 years, 48 % males) with no clinical evidence of HF. Patients were prospectively followed over 49.8 ± 6.7 months for the development of cardiac death, HF hospitalization, and nonfatal myocardial infarction.
  
  
  RESULTS
  Patients with NT-proBNP above the 80th age- and gender-specific percentile showed a threefold risk of events as compared to those with NT-proBNP under this cut-off [hazard ratio 3.2 (2.6-8.3), p < 0.0001]. In multivariable analysis, NT-proBNP added independent and incremental prognostic information to a predictive model including established risk factors (p < 0.0001). After stratification by age, increased NT-proBNP predicted outcome among patients in the second and third age tertiles, but not among those in the first tertile. Increased NT-proBNP was associated with a 3.6-fold risk in women and a 2.9-fold risk in men. Addition of the gender-NT-proBNP interaction to prognostic models further improved prediction of events (p = 0.014).
  
  
  CONCLUSIONS
  NT-proBNP measurement adds independent and incremental information for the prediction of clinical outcome in asymptomatic, stage A-B HF hypertensive and diabetic patients taken from primary care. This prognostic value might be further evident in the elderly and among women.
authors.affiliation: Department of Cardiology, S. Maria Annunziata Hospital, Via dell'antella 58, Florence, Italy. pcballo@tin.it.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.affiliation: Department of Cardiology, S. Maria Annunziata Hospital, Via dell'antella 58, Florence, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Betti
authors.affiliation: Institute for Oncological Studies and Prevention, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.affiliation: Epidemiology Unit, Local Health Authority, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.affiliation: Department of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Castelli
authors.affiliation: Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.affiliation: Regional Health Agency, Local Health Authority, Florence, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Zuppiroli
mesh_terms: D000367:Age Factors; D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Diabetes; Hypertension; Natriuretic peptide; Primary care; Risk stratification