It has been clinically demonstrated that hypertensive patients, even with controlled blood pressure (BP), have a higher incidence of cardiovascular events than normotensive patients.1 This has been attributed to an underlying residual cardiovascular risk (RCR) and is due to the fact that treatment of hypertension cannot completely reverse the sustained vascular damage as well as other cardiovascular morbid conditions. 1 Therefore, some researchers have investigated several biomarkers that better predict the cardiovascular consequences of the RCR.2 Of all biomarkers used, the best predictor has been the brain natriuretic peptide (BNP) and its inactive fragment N-terminal pro-brain natriuretic peptide (NT-proBNP) in hypertension and other disease states.3,4 Increased levels of RCR have been associated with a 50% increased risk of future cardiovascular events not only in controlled hypertensive patients, but also in patients with other cardiovascular diseases.5 Therefore, the baseline measurement of blood levels of NT-proBNP in either newly diagnosed untreated or pretreated hypertensive patients is important for the evaluation of RCR and its predictive value for future cardiovascular events. In order to get a better perspective of the current status of RCR and its predictive significance, a Medline search of the English language literature was conducted from 2010 to 2015 and 14 pertinent papers were selected. The findings from these studies together with collateral literature will be discussed in this commentary.
CLINICAL DIAGNOSTIC SIGNIFICANCE OF NT-PROBNPThe brain (B-type) natriuretic peptide (BNP) is a 32-amino acid polypeptide secreted by ventricular myocytes in response to the stretching effect of pressure or volume overload of the left ventricle, and its levels correlate with the degree of left ventricular dysfunction (LVD). Circulating levels of BNP and its inactive metabolite NT-proBNP are very low in healthy individuals, but they increase significantly in response to myocardial stress. 4,6 Therefore, the measurement of BNP and especially NT-proBNP, as a result of its long half-life, have been used for the early detection of LVD secondary to hypertension, myocardial ischemia, and heart failure (HF). Several studies have shown good correlation between the levels of NT-proBNP and stage of LVD. Consequently, NT-proBNP has been used for the detection of RCR and the prediction of future cardiovascular events in the general population and in patients with hypertension, cardiovascular disease (CVD), coronary heart disease (CHD), and HF. The measurement of NT-proBNP has been used effectively for the diagnosis of subclinical LVD and HF in primary care and is cost-effective in that it replaced the use of echocardiography.7,8 An NT-proBNP level <180 pg/mL ruled out major LVD and avoided the use of echocardiography and the referral to specialized centers in 38% and 23% of the cases, respectively.7 In another study, NT-proBNP levels ≤400 pg/mL or ≤300 pg/mL for initial evaluation and sequential follow-up reduced the us...