Plasma brain natriuretic peptide in assessment of acute dyspnoea

Davis, Mark E.; Espiner, Eric A.; Yandle, Timothy G.; Richards, Grace; Town, Ian; Neill, Alister; Drennan, C.; Richards, A. Mark; Turner, John G.; Billings, Joshua D

doi:10.1016/s0140-6736(94)92690-5

Cited by 466 publications

(270 citation statements)

References 12 publications

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“…25 In the present study, the mean BNP level of the elevated group was 51.4±40.4 pg/ml. These patients with an increased BNP level had diastolic dysfunction, but preserved systolic function, in addition to hypertrophy.…”

Section: Bnp and Heart Diseasesupporting

confidence: 46%

Clinical Significance of B-Type Natriuretic Peptide in the Assessment of Untreated Hypertension

Seki

Tsurusaki

Kasai

et al. 2008

Circ J

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ypertension is widely recognized as a major risk factor for cardiovascular disease. 1,2 When initiating antihypertensive treatment, it is important to assess clinical characteristics and the severity of organ damage. [3][4][5] The plasma level of B-type natriuretic peptide (BNP) is well established as a useful marker of cardiac dysfunction, prognosis and response to treatment in patients with heart failure. [6][7][8][9] In patients with heart failure, secretion of BNP increases in proportion to the severity of left ventricular (LV) dysfunction, as indicated by the pulmonary capillary wedge pressure and LV end-diastolic pressure or the New York Heart Association class. 6,10 However, the measurement of BNP for clinical guidelines in hypertension is not recommended at present. 5 It has been reported that BNP is also increased in hypertensive patients without heart failure and in community residents with hypertension. 11-14 Hypertensive patients with cardiac hypertrophy have higher plasma BNP concentrations and the patients with increased BNP suffer from a higher incidence of cardiac events. 11,12 Recently, diastolic failure has attracted more attention in relation to hypertensive heart disease and this is associated with an increase in BNP. 15,16 Early and accurate diagnosis of diastolic failure is important to improve the prognosis of patients with heart failure. However, the role of BNP in the clinical assessment of hypertension has not been fully investigated and the actual meaning of a slight increase in BNP is still unclear. [11][12][13] The Framingham study demonstrated that an increase in BNP predicted the risk of death and cardiovascular events in community residents. 17 Neurohumoral factors become activated and play important roles in the pathophysiology of chronic heart disease. It would be helpful in general practice if BNP could be used as a marker of the risk of cardiovascular events in hypertensive patients.In the present study, we examined the relationship between plasma BNP levels and various clinical parameters to assess the usefulness of BNP as a marker for the severity of hypertension or organ damage in untreated hypertensives. The patients were clinically graded by BNP level. MethodsThe present study group comprised 154 persons with essential hypertension who attended our outpatient clinic (84 Circ J 2008; 72: 770 -777 (Received July 30, 2007; revised manuscript received October 22, 2007; accepted December 19, 2007 Methods and ResultsThe relationship between the plasma BNP level and various clinical parameters was examined in 154 untreated hypertensive patients without heart failure or atrial fibrillation (mean age: 58.0±10.7; mean blood pressure: 164.5±15.2/99.1±9.7 mmHg; mean BNP: 32.7±36.7 pg/ml). First, the patients were divided into 2 groups based on BNP: normal (<18.5 pg/ml, mean 9.7±5.7, n=69); or elevated (>18.5 pg/ml, mean 51.4± 40.4, n=85). The elevated BNP group had a significantly greater electrocardiographic voltage index (SV1+RV5; 3.7±1.2 vs 3.2±0.8 mV, p=0.0029), cardiothora...

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Section: Bnp and Heart Diseasesupporting

confidence: 46%

Clinical Significance of B-Type Natriuretic Peptide in the Assessment of Untreated Hypertension

Seki

Tsurusaki

Kasai

et al. 2008

Circ J

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“…5 , após medirem fator natriurético atrial e peptídeo natriurético tipo-B em 52 pacientes com dispnéia na sala de emergência, demonstraram que o peptídeo natriurético tipo-B plasmático à admissão indicou o diagnóstico correto com mais acurácia que a fração de ejeção do ventrí-culo esquerdo e o fator natriurético atrial. Dao e cols.…”

Section: Peptídeo Natriurético Tipo-b Como Ferramenta Diagnósticaunclassified

Peptídeo natriurético tipo-B e doenças cardiovasculares

Beck-da-Silva¹,

Ferreira²,

Blacher³

et al. 2003

Arq. Bras. Cardiol.

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Atualização "Cardiologistas e internistas têm agora uma ferramenta para determinar se o paciente tem insuficiência cardíaca e/ou avaliar sua severidade, assim como os médicos, rotineiramente, solicitam creatinina sérica para determinar se o paciente tem doença renal ou testes de função hepática em pacientes com doenças do fígado." K.L. Baughman, Johns HopkinsA descoberta de uma ligação endocrinológica entre o coração e os rins baseia-se em achados de microscopia eletrônica em que células de músculo estriado dos átrios de mamíferos se diferenciam tanto em células contráteis como em células endócrinas. O fator natriurético atrial (FNA), um peptídeo circulante com propriedades natriuréticas, diuréticas e vasodilatadoras, foi descoberto em 1980 por A. J. de Bold, e considerado, na ocasião, como a ligação hormonal entre o coração e os rins. Desde então, um imenso número de investigações multidisciplinares tem sido conduzido para esclarecer o real papel deste peptídeo na patogênese das doenças cardiovasculares, na regulação da pressão arterial e na excreção de sal e água. Essas investigações acabaram se tornando um excelente exemplo de pesquisa evoluída da bancada do laboratório à beira do leito do paciente. Hoje, o peptídeo natriurético tipo-B (PNB) vem gradual e lentamente se estabelecendo na área clínica.O objetivo deste artigo é prover o clínico de uma revisão atualizada dos progressos ocorridos até o momento, a fim de incluir o peptídeo natriurético tipo-B na prática clínica diária. Os peptídeos natriuréticosFNA, PNB (também chamado de peptídeo natriurético cerebral), e o peptídeo natriurético tipo C (PNC) constituem a família dos peptídeos natriuréticos 2 . Seu papel principal é a participação na homeostase cardiovascular e na modulação do crescimento celular. O RNAm de fator natriurético atrial foi encontrado em muitos tecidos, mas é particularmente abundante nos átrios cardíacos. O peptídeo natriurético tipo-B foi, primeiramente, isolado de homogenados de cére-bro, mas também é encontrado na circulação periférica. No entanto, sua maior concentração encontra-se no tecido miocárdico. Tanto o fator natriurético atrial como o peptídeo natriurético tipo-B são produzidos, normalmente, pelas cé-lulas de músculo atrial, de onde são liberados. Entretanto, sob condições atípicas, como a doença estrutural miocárdi-ca, o peptídeo natriurético tipo-B parece ser produzido em maior escala pelos ventrículos 3 .Os peptídeos natriuréticos, em conjunto, contrabalançam os efeitos do sistema renina-angiotensina-aldosterona (SRAA). As concentrações plasmáticas de FNA e peptídeo natriurético tipo-B aumentam em resposta à distensão do tecido atrial e parecem ser antagonistas dos efeitos da angiotensina II no tônus vascular, na secreção de aldosterona, na reabsorção de sódio e no crescimento celular vascular. O peptídio natriurético tipo-C é encontrado, predominantemente, no cérebro e em células endoteliais e as concentrações no plasma são muito baixas 4 . Por isto, os peptídeos natriuréticos mais amplamente estudados em doenças cardi...

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“…Circulating levels of the cardiac natriuretic peptides, particularly brain natriuretic peptide (BNP) and the 1-76 amino-acid N-terminal pro-BNP (NT-proBNP), have been identified as robust biochemical markers of heart failure in patients presenting with acute shortness of breath, [1][2][3][4] as prognostic indices for mortality and the development of heart failure following acute myocardial infarction, 5,6 and as potentially useful guides to the intensity of pharmacotherapy in patients with chronic heart failure. 7 Natriuretic peptide levels have been reported also to be higher in patients with hypertension, especially those with left ventricular hypertrophy or dysfunction, than in normotensive subjects.…”

Section: Introductionmentioning

confidence: 99%

Plasma N terminal pro-brain natriuretic peptide levels and its determinants in a multi-ethnic population

et al. 2007

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This study documents the determinants and plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) among hypertensive and normotensive subjects in a multi-ethnic population in the United Arab Emirates (UAE). We obtained demographic, anthropometric and clinical data, together with fasting NT-proBNP and biochemical indices from 128 hypertensive patients and 138 normotensive subjects matched for age, gender and ethnicity. Plasma NT-proBNP levels were significantly (Po0.001), and several-fold higher among hypertensives (median 5.92, inter quartile range (IQR): 1.79-18.48 pmol/l) than normotensives (median 1.78, IQR: 0.59-4.32 pmol/l) in the total study population, and the same was true for the ethnic groups separately. Similarly, plasma levels of glucose, blood urea nitrogen (BUN) and creatinine, but not insulin, were significantly (Po0.05) higher among hypertensives than normotensives. For all subjects combined, log NT-proBNP correlated positively and significantly with age (Po0.01), log glucose (Po0.05), systolic blood pressure (SBP, Po0.001), log BUN (Po0.001) and log creatinine (Po0.001). Multivariate regression analysis showed that NT-proBNP levels were independently and positively correlated with SBP, age, gender, log BUN, Emirati and South East Asian ethnic groups and inversely associated with current exercise. In conclusion, we found circulating levels of NT-proBNP to be significantly increased in hypertensive versus normotensive subjects in the UAE and independently related to SBP, age, gender, indices of renal function and possibly exercise. Our results further suggest a possible modulating effect of ethnicity on NT-proBNP levels.

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Plasma brain natriuretic peptide in assessment of acute dyspnoea

Cited by 466 publications

References 12 publications

Clinical Significance of B-Type Natriuretic Peptide in the Assessment of Untreated Hypertension

Clinical Significance of B-Type Natriuretic Peptide in the Assessment of Untreated Hypertension

Peptídeo natriurético tipo-B e doenças cardiovasculares

Plasma N terminal pro-brain natriuretic peptide levels and its determinants in a multi-ethnic population

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