| Institution: | 1. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA;2. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA;3. Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas, USA;4. Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;5. Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA;6. Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;7. Department of Epidemiology, Human Genetics, and Environmental Sciences School of Public Health University of Texas Health Science Center at Houston, Houston, Texas, USA;8. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA;9. Harvard Medical School, Brigham and Women''s Hospital Heart and Vascular Center, Boston, Massachusetts, USA |
| Abstract: | BackgroundAlthough intensive blood pressure reduction has cardiovascular benefits, the absolute benefit is greater in those at higher cardiovascular disease (CVD) risk.ObjectivesThis study examined whether N-terminal pro–B-type natriuretic peptide (NT-proBNP) helps identify subjects at higher risk for CVD events across systolic blood pressure (SBP), diastolic blood pressure (DBP), or pulse pressure (PP) categories.MethodsParticipants from the ARIC (Atherosclerosis Risk In Communities) study visit 4 (1996 to 98) were grouped according to SBP, DBP, or PP categories and further stratified by NT-proBNP categories. Cox regression models were used to estimate hazard ratios for incident CVD (coronary heart disease, ischemic stroke, or heart failure hospitalization) and mortality across combined NT-proBNP and/or BP categories, adjusting for CVD risk factors.ResultsThere were 9,309 participants (age: 62.6 ± 5.6 years; 58.3% women) with 2,416 CVD events over a median follow-up of 16.7 years. Within each SBP, DBP, or PP category, a higher category of NT-proBNP (100 to <300 or 300 pg/ml, compared with NT-proBNP <100 pg/ml) was associated with a graded increased risk for CVD events and mortality. Participants with SBP 130 to 139 mm Hg but NT-proBNP ≥300 pg/ml had a hazards ratio of 3.4 for CVD (95% confidence interval: 2.44 to 4.77) compared with a NT-proBNP of <100 pg/ml and SBP of 140 to 149 mm Hg.ConclusionsElevated NT-proBNP is independently associated with CVD and mortality across SBP, DBP, and PP categories and helps identify subjects at the highest risk. Participants with stage 1 hypertension but elevated NT-proBNP had greater cardiovascular risk compared with those with stage 2 SBP but lower NT-proBNP. Future studies are needed to evaluate use of biomarker-based strategies for CVD risk assessment to assist with initiation or intensification of BP treatment. |
