The Value of N-Terminal Pro–B-Type Natriuretic Peptide in Determining Antihypertensive Benefit

Welsh, Paul; Poulter, Neil; Chang, Choon Lan; Sever, Peter; Sattar, Naveed

doi:10.1161/hypertensionaha.113.02204

Cited by 26 publications

(22 citation statements)

References 32 publications

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“…A recent study found that NT-proBNP was positively associated with visit-to-visit variability in BP determined as the SD of repeated office BP values [22]. That study may support our findings, although it was conducted in treated hypertensive patients with at least three other risk factors for cardiovascular disease [22].…”

Section: Discussionsupporting

confidence: 86%

Association between N-terminal pro B-type natriuretic peptide and day-to-day blood pressure and heart rate variability in a general population

Satoh

Miki

Asayama

et al. 2015

Journal of Hypertension

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Section: Discussionsupporting

confidence: 86%

Association between N-terminal pro B-type natriuretic peptide and day-to-day blood pressure and heart rate variability in a general population

Satoh

Miki

Asayama

et al. 2015

Journal of Hypertension

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“…The risk of death with the highest NTproBNP tertile (≥133 pg/mL) was 3.3 times higher than the lowest tertile (<50.8 pg/mL) (HR, 3.30; 95% CI, 10.90-12.29). Similar findings have been reported by Welsh and colleagues 14 in hypertensive patients free of CHD at baseline from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). This study showed that NTproBNP predicted CVD risk independently of BP variation (odds ratio [OR], 1.24; 95% CI, 1.06-1.45).…”

Section: Studies Demonstrating the Value Of Bnps For The Detection Ofsupporting

confidence: 88%

“…The findings of the PONTIAC study are at variance with the findings of the much larger ASCOT study, in which the b-blockerbased regimen (atenolol) resulted in a significant increase (69.6%) in NT-proBNP levels compared with a significant decrease (36.5%) with the calcium channel blocker-based (amlodipine) regimen. 14 The increased NT-proBNP levels with b-blockers has been attributed to the increased diastolic filling time and to left ventricular stretch. In addition, the selection of the bblocker used in the PONTIAC study is questionable because of its adverse effects in glucose regulation.…”

Section: Treatment Of Residual Cardiovascular Riskmentioning

confidence: 99%

The Clinical Significance of N‐terminal Pro‐brain Natriuretic Peptide in Detecting the Residual Cardiovascular Risk in Hypertension and Other Clinical Conditions and in Predicting Future Cardiovascular Events

Chrysant

2016

J of Clinical Hypertension

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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...

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“…Although the baseline NT-proBNP levels in the present study were low and within normal limits, the extent of reduction in NT-proBNP levels was numerically greater with sacubitril/valsartan than with amlodipine or atenolol, despite a greater BP reduction, in the ASCOT study (Anglo-Scandinavian Cardiac Outcomes Trial). 41 The decrease in plasma aldosterone concentrations after treatment with both sacubitril/valsartan and valsartan is considered to be related to AT 1 receptor blockade and indicates that both treatments are conferring cardiovascular benefits owing to RAAS inhibition.…”

Section: Discussionmentioning

confidence: 99%

Effects of Sacubitril/Valsartan (LCZ696) on Natriuresis, Diuresis, Blood Pressures, and NT-proBNP in Salt-Sensitive Hypertension

et al. 2017

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S alt-sensitive hypertension (SSH) is characterized by an increase in blood pressure (BP) in response to sodium load and is associated with an increased risk of cardiovascular events. [1][2][3] Owing to high dietary salt intake and genetic predisposition, salt sensitivity of BP is of particular clinical relevance in Asian populations. [4][5][6][7][8] Considering its pathophysiology, thiazide-type diuretics are the preferred antihypertensive agents for patients with SSH.9-11 However, conditions such as hyponatremia and hypokalemia caused by thiazide-type diuretics often contribute to morbidity and mortality, if left unrecognized. Hence, antihypertensive agents that improve urinary sodium excretion without altering electrolyte concentrations would be a better therapeutic option for patients with SSH. Among multiple pathophysiological mechanisms, a relative deficiency of atrial natriuretic peptide (ANP) is considered to result in sodium retention and a suboptimal vasodilatory response to sodium loading observed in patients with SSH.12-15 The renin-angiotensin-aldosterone system (RAAS) also plays a role in the pathogenesis of SSH by modulating renal sodium reabsorption.16 Therefore, enhancing the activity of natriuretic peptides along with inhibition of the RAAS may be an effective, Abstract-Salt-sensitive hypertension (SSH) is characterized by impaired sodium excretion and subnormal vasodilatory response to salt loading. Sacubitril/valsartan (LCZ696) was hypothesized to increase natriuresis and diuresis and result in superior blood pressure control compared with valsartan in Asian patients with SSH. In this randomized, doubleblind, crossover study, 72 patients with SSH received sacubitril/valsartan 400 mg and valsartan 320 mg once daily for 4 weeks each. SSH was diagnosed if the mean arterial pressure increased by ≥10% when patients switched from low (50 mmol/d) to high (320 mmol/d) sodium diet. The primary outcome was cumulative 6-and 24-hour sodium excretion after first dose administration. Compared with valsartan, sacubitril/valsartan was associated with a significant increase in natriuresis (adjusted treatment difference: 24.5 mmol/6 hours, 50.3 mmol/24 hours, both P<0.001) and diuresis (adjusted treatment difference: 291.2 mL/6 hours, P<0.001; 356.4 mL/24 hours, P=0.002) on day 1, but not on day 28, and greater reductions in office and ambulatory blood pressure on day 28. Despite morning dosing of both drugs, ambulatory blood pressure reductions were more pronounced at nighttime than at daytime or the 24-hour average. Compared with valsartan, sacubitril/valsartan significantly reduced N-terminal pro B-type natriuretic peptide levels on day 28 (adjusted treatment difference: −20%; P=0.001). Sacubitril/valsartan and valsartan were safe and well tolerated with no significant changes in body weight or serum sodium and potassium levels with either treatments. In conclusion, sacubitril/valsartan compared with valsartan was associated with short-term increases in natriuresis and diuresis, superior office and ambulato...

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The Value of N-Terminal Pro–B-Type Natriuretic Peptide in Determining Antihypertensive Benefit

Cited by 26 publications

References 32 publications

Association between N-terminal pro B-type natriuretic peptide and day-to-day blood pressure and heart rate variability in a general population

Association between N-terminal pro B-type natriuretic peptide and day-to-day blood pressure and heart rate variability in a general population

The Clinical Significance of N‐terminal Pro‐brain Natriuretic Peptide in Detecting the Residual Cardiovascular Risk in Hypertension and Other Clinical Conditions and in Predicting Future Cardiovascular Events

Effects of Sacubitril/Valsartan (LCZ696) on Natriuresis, Diuresis, Blood Pressures, and NT-proBNP in Salt-Sensitive Hypertension

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