Background: N-terminal pro-brain natriuretic peptide (NtproBNP) and N -termi nal pro-atrial natriuretic peptide (Nt-proANP) are strong cardiovascular risk markers in patients with chronic heart failure, as well as in ...Background: N-terminal pro-brain natriuretic peptide (NtproBNP) and N -termi nal pro-atrial natriuretic peptide (Nt-proANP) are strong cardiovascular risk markers in patients with chronic heart failure, as well as in the general popula tion. We investigated whether high Nt-proBNP or NtproANP could also predict the composite endpoint (CEP) of cardiovascular death, non-fatal stroke or non-fat al myocardial infarction in patients with hypertension and left ventricular (LV) hypertrophy. Methods: After 2 weeks of placebo treatment, clinical, laboratory and echocardiographic variables were assessed in 183 hypertensive participants i n the LIFE echo substudy with electrocardiographic LV hypertrophy. Nt-proBNP an d Nt-proANP were measured by immunoassay at baseline. The patients were followe d for 60 ±5 months. Results: Using Cox regression analysis, the 25 CEP were pre dicted by In(Nt-proBNP) (hazard ratio 1.61 per 2.73-fold increase, P < 0.01) a s well as In(Nt-pro-ANP) (hazard ratio 2.93, P < 0.05). Nt-proBNP above the m edian value of 21.8 pmol/ml was associated with higher incidence of CEP (19.6 versus 7.7%, P < 0.05). Nt-proBNP above the median value was associated with higher incidence of CEP in the 123 patients without history of diabetes or cardiovascular diseas e (14.8 versus 4.3%, P < 0.05), but the association was insignificant in the 60 patients with a history of diabetes or cardiovascular disease (26.3 versus 18.2 %, NS). Nt-proANP showed the same tendency. Conclusion: Nt-proBNP, more than Nt-proANP, strongly predicts cardiovascular events in patients with hypertensio n and LV hypertrophy, especially in patients without diabetes or clinically over t cardiovascular disease.展开更多
Background: Secretion of natriuretic peptides is related to cardiac wall stress and influenced by the renin-angiotensin system. Therefore,we investigated the influence of blood pressure(BP)reduction with losartan vers...Background: Secretion of natriuretic peptides is related to cardiac wall stress and influenced by the renin-angiotensin system. Therefore,we investigated the influence of blood pressure(BP)reduction with losartan versus atenolol on N-terminal pro-atrial natriuretic peptide(Nt-proANP) and N-terminal pro-brain natriuretic peptide(Nt-proBNP). Methods: In 183 patients with hypertension and electrocardiographic left ventricular(LV) hypertrophy, enrolled in the LIFE Study, we measured BP and serum Nt-proANP and Nt-proBNP by immunoassay after 2 weeks of placebo treatment and after 1, 2, 4, 6, 12, 24, 36 and 48 months of randomized treatment with losartan-or atenolol-based antihypertensive regimens. Results: There was no significant difference in BP at any time point between the two treatment groups. In patients treated with losartan, median Nt-proANP decreased gradually throughout the study, reaching significance after 6months of treatment(1125-1060 pmol/l,P< 0.001), and Nt-proBNP decreased within the first month(24.7-18.7 pmol/l, P< 0.01) and stayed reduced throughout the study. During losartan-based antihypertensive treatment, Nt-proANP and Nt-proBNP as a percentage of baseline values were correlated to reductions in systolic BP(r=0.11, P< 0.01 and r=0.10, P=0.01) and diastolic BP(r=0.17, P< 0.001 and r=0.07, P=0.09). In atenolol-treated patients, Nt-proANP(1100-1640 pmol/l, P< 0.001) and Nt-proBNP(20.0-37.7 pmol/l, P< 0.001) increased during the first month, and remained elevated throughout the study. During atenolol-based antihypertensive treatment, changes in Nt-proANP(r=-0.16, P< 0.001) and NtproBNP(r=-0.07, P=0.08) were negatively related to change in heart rate. Conclusion: Nt-proANP and Nt-proBNP were reduced in parallel with BP in losartan-treated patients whereas they increased in parallel with decreased heart rate in atenolol-treated patients.展开更多
文摘Background: N-terminal pro-brain natriuretic peptide (NtproBNP) and N -termi nal pro-atrial natriuretic peptide (Nt-proANP) are strong cardiovascular risk markers in patients with chronic heart failure, as well as in the general popula tion. We investigated whether high Nt-proBNP or NtproANP could also predict the composite endpoint (CEP) of cardiovascular death, non-fatal stroke or non-fat al myocardial infarction in patients with hypertension and left ventricular (LV) hypertrophy. Methods: After 2 weeks of placebo treatment, clinical, laboratory and echocardiographic variables were assessed in 183 hypertensive participants i n the LIFE echo substudy with electrocardiographic LV hypertrophy. Nt-proBNP an d Nt-proANP were measured by immunoassay at baseline. The patients were followe d for 60 ±5 months. Results: Using Cox regression analysis, the 25 CEP were pre dicted by In(Nt-proBNP) (hazard ratio 1.61 per 2.73-fold increase, P < 0.01) a s well as In(Nt-pro-ANP) (hazard ratio 2.93, P < 0.05). Nt-proBNP above the m edian value of 21.8 pmol/ml was associated with higher incidence of CEP (19.6 versus 7.7%, P < 0.05). Nt-proBNP above the median value was associated with higher incidence of CEP in the 123 patients without history of diabetes or cardiovascular diseas e (14.8 versus 4.3%, P < 0.05), but the association was insignificant in the 60 patients with a history of diabetes or cardiovascular disease (26.3 versus 18.2 %, NS). Nt-proANP showed the same tendency. Conclusion: Nt-proBNP, more than Nt-proANP, strongly predicts cardiovascular events in patients with hypertensio n and LV hypertrophy, especially in patients without diabetes or clinically over t cardiovascular disease.
文摘Background: Secretion of natriuretic peptides is related to cardiac wall stress and influenced by the renin-angiotensin system. Therefore,we investigated the influence of blood pressure(BP)reduction with losartan versus atenolol on N-terminal pro-atrial natriuretic peptide(Nt-proANP) and N-terminal pro-brain natriuretic peptide(Nt-proBNP). Methods: In 183 patients with hypertension and electrocardiographic left ventricular(LV) hypertrophy, enrolled in the LIFE Study, we measured BP and serum Nt-proANP and Nt-proBNP by immunoassay after 2 weeks of placebo treatment and after 1, 2, 4, 6, 12, 24, 36 and 48 months of randomized treatment with losartan-or atenolol-based antihypertensive regimens. Results: There was no significant difference in BP at any time point between the two treatment groups. In patients treated with losartan, median Nt-proANP decreased gradually throughout the study, reaching significance after 6months of treatment(1125-1060 pmol/l,P< 0.001), and Nt-proBNP decreased within the first month(24.7-18.7 pmol/l, P< 0.01) and stayed reduced throughout the study. During losartan-based antihypertensive treatment, Nt-proANP and Nt-proBNP as a percentage of baseline values were correlated to reductions in systolic BP(r=0.11, P< 0.01 and r=0.10, P=0.01) and diastolic BP(r=0.17, P< 0.001 and r=0.07, P=0.09). In atenolol-treated patients, Nt-proANP(1100-1640 pmol/l, P< 0.001) and Nt-proBNP(20.0-37.7 pmol/l, P< 0.001) increased during the first month, and remained elevated throughout the study. During atenolol-based antihypertensive treatment, changes in Nt-proANP(r=-0.16, P< 0.001) and NtproBNP(r=-0.07, P=0.08) were negatively related to change in heart rate. Conclusion: Nt-proANP and Nt-proBNP were reduced in parallel with BP in losartan-treated patients whereas they increased in parallel with decreased heart rate in atenolol-treated patients.
