Key result
In asymptomatic hypertensive subjects, higher N-terminal pro B-type natriuretic peptide independently predicted a coronary artery calcium score >75th percentile (OR 1.87; 95% CI 1.30-2.74; P=0.001).
Why the study?
Established biohumoral markers for the diagnosis of atherosclerosis are lacking in asymptomatic subjects with hypertension.
Case-Control (n=872)
May flag subclinical atherosclerosis in asymptomatic hypertension; hypothesis-generating and should not yet change practice or guidelines.
BACKGROUND: Arterial hypertension is a main determinant of arterial remodelling and atherosclerosis. Coronary artery calcium score and carotid intima-media thickness are recognized indices of vascular remodelling. Established biohumoral markers for the diagnosis of atherosclerosis are still lacking in asymptomatic subjects with hypertension. OBJECTIVES: We aimed to test the association of plasma N-terminal pro B-type natriuretic peptide concentrations with either coronary artery calcium score or carotid intima-media thickness in asymptomatic hypertensive subjects. METHODS: We conducted a case-control study on 436 hypertensi.ve and 436 age/sex-matched normotensive subjects from the population of the Montignoso HEart and Lung Project, a community-based study of asymptomatic general population ≥45 years. Subjects underwent N-terminal pro B-type natriuretic peptide measurement, echocardiography and evaluation of coronary artery calcium score and carotid intima-media thickness. RESULTS: Hypertensive subjects had higher median coronary artery calcium score (60 (interquartile range, 30-112) vs. 15 (interquartile range 3-70) Agatson units, p = 0.007), carotid intima-media thickness (8.6 (interquartile range 7.5-9.1) vs. 7.9 (7.1-8.4) µm, p < 0.001) and indexed left ventricular mass (101 (interquartile range 82-126) vs. 87 (63-91) mg/m2, p = 0.03) than controls, with no differences in left ventricular ejection fraction, diameters, E/E', left atrial area. N-terminal pro B-type natriuretic peptide concentrations were higher in hypertensive subjects with either coronary artery calcium score (p = 0.008) or carotid intima-media thickness >75th (p < 0.006) percentile and highest in combined coronary artery calcium score/carotid intima-media thickness >75th percentile (p = 0.021). In multivariable analysis, N-terminal pro B-type natriuretic peptide independently predicted either coronary artery calcium score or carotid intima-media thickness >75th percentile, but only in hypertensive subjects (odds ratio = 1.87, 95% confidence interval 1.30-2.74, p = 0.001 and odds ratio = 1.99, 95% confidence interval 1.43-2.76, p = 0.001). CONCLUSIONS: In asymptomatic subjects with hypertension, N-terminal pro B-type natriuretic peptide is a marker of hypertension-mediated preclinical vascular disease.
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Pastormerlo et al. (2015) conducted a case-control in Asymptomatic hypertension (n=872). N-terminal pro B-type natriuretic peptide was evaluated on Coronary artery calcium score >75th percentile (OR 1.87, 95% CI 1.30-2.74, p=0.001). In asymptomatic hypertensive subjects, higher N-terminal pro B-type natriuretic peptide independently predicted a coronary artery calcium score >75th percentile (OR 1.87; 95% CI 1.30-2.74; P=0.001).
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