What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Asymptomatic hypertension (n=41). Intervention: High BNP vs. Low BNP. Primary outcome: Left ventricular mass index (LVMI) (p=0.03).

November 12, 2012Open Access

Modest Elevation in BNP in Asymptomatic Hypertensive Patients Reflects Sub-Clinical Cardiac Remodeling, Inflammation and Extracellular Matrix Changes

Q: What does this research mean for the field?

In asymptomatic hypertensive patients, modest elevations in BNP are associated with sub-clinical cardiac remodeling, inflammation, and extracellular matrix alterations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Resultado clave

In asymptomatic hypertensive patients, a modest elevation in BNP was associated with significantly greater left ventricular mass index (118 vs 97 g/m2) and increased coronary sinus expression of fibro-inflammatory biomarkers.

Diseño del estudio

Tipo

Cross-Sectional (n=41)

Multicéntrico

PICO estructurado

Does a modest elevation in BNP correlate with sub-clinical cardiac remodeling, inflammation, and extracellular matrix changes in asymptomatic hypertensive patients?

Población

41 asymptomatic hypertensive patients

Intervención

High BNP levels (n=27)

Comparador

Low BNP levels (n=14)

Resultado

Sub-clinical evidence of cardiac remodeling (left ventricular mass index, left atrial volume index), inflammation (TNF-α, IL-6, IL-8, hsCRP), and extracellular matrix alterations (PINP, CITP, PIIINP)surrogate

Modest elevations in BNP in asymptomatic hypertensive patients reflect early sub-clinical pathological processes including cardiac remodeling, inflammation, and extracellular matrix alterations.

Resultado numérico

Tasa de eventos absoluta: 118% vs 97%

valor p: p=0.03

Limitaciones

Used serum markers of collagen turnover taken from the coronary sinus as a surrogate of myocardial interstitial disease without endomyocardial biopsy evidence of fibrosis
Excluded patients with diseases that alter collagen and inflammatory markers
Increased usage of beta-blockers in the elevated BNP cohort
Blood pressure readings were taken from a single reading and by multiple operators

Resumen

In asymptomatic subjects B-type natriuretic peptide (BNP) is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM) alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n = 14) and high BNP (n = 27). Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001). CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008), CITP (r = 0.35, p = 0.03) and PIIINP (r = 0.35, p = 0.001), and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002), IL-6 (r = 0.35, p = 0.04), and IL-8 (r = 0.54, p<0.001). The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007), TNF-α (3.2±0.5 versus 3.7±1.1, p = 003), IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02) and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04), and greater left ventricular mass index (97±20 versus 118±26 g/m(2), p = 0.03) and left atrial volume index (18±2 versus 21±4, p = 0.008). Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

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