NT-proBNP predicted cardiovascular disease events independently of blood pressure variation (OR 1.24; 95% CI 1.06-1.45; P=0.007) and improved risk prediction beyond established predictors.
RCT (n=6,549)
Yes
Does NT-proBNP predict cardiovascular disease events and benefit from amlodipine-based versus atenolol-based antihypertensive regimens in patients with hypertension?
NT-proBNP improves cardiovascular risk prediction in hypertensive patients and may help assess the efficacy of specific antihypertensive regimens, with amlodipine-based treatment reducing NT-proBNP levels.
Effect estimate: OR 1.24 (95% CI 1.06-1.45)
p-value: p=0.007
We investigated 3 hypotheses: (1) N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular disease events in patients with hypertension, (2) NT-proBNP is associated with blood pressure variability, and (3) NT-proBNP predicts benefit from antihypertensive regimens. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized a subset of 6549 patients at risk with no history of coronary heart disease to either atenolol-based or amlodipine-based blood pressure-lowering treatment. During 5.5 years of follow-up, 485 cardiovascular disease cases accrued and were matched with 1367 controls. Baseline and 6-month in-trial NT-proBNP were measured. The results show that NT-proBNP improves cardiovascular disease risk prediction beyond established predictors, continuous net reclassification improvement of 22.3% (P<0.0001). Furthermore, a 1-mm Hg increase in the SD of systolic blood pressure was associated with 2% higher baseline NT-proBNP in a multivariable regression analysis (P<0.0001). However, NT-proBNP predicted cardiovascular disease risk independently of blood pressure variation (odds ratio per SD increase in log NT-proBNP 1.24; 95% confidence interval, 1.06-1.45; P=0.007). Atenolol-based treatment led to a 69.6% increase in NT-proBNP at 6 months (P<0.0001). In contrast, amlodipine-based treatment reduced NT-proBNP by 36.5% (P<0.0001). Amlodipine recipients who achieved a 6-month NT-proBNP below the median (61 pg/mL) were at lower risk of cardiovascular disease when compared with those who did not (odds ratio, 0.58; 95% confidence interval, 0.37-0.91) after adjustment for confounders inclusive of baseline NT-proBNP and achieved blood pressure. If confirmed, these novel results suggest that NT-proBNP, as well as aiding cardiovascular disease risk assessment, may also help assess the efficacy of specific antihypertensive regimens. Further relevant studies seem warranted.
Welsh et al. (Tue,) conducted a rct in Hypertension (n=6,549). Amlodipine-based treatment vs. Atenolol-based treatment was evaluated on Cardiovascular disease events (OR 1.24, 95% CI 1.06-1.45, p=0.007). NT-proBNP predicted cardiovascular disease events independently of blood pressure variation (OR 1.24; 95% CI 1.06-1.45; P=0.007) and improved risk prediction beyond established predictors.