Key result
High BNP linked to ~80% higher CVD risk, partially mediated by sleep systolic BP.
Why the study?
B-type natriuretic peptide is a risk marker for heart failure and cardiovascular diseases, and this study investigated the possible mediating role of sleep blood pressure in the association between BNP and CVD events.
Cohort (n=5,751)
Hazard Ratio: 1.8 (95% CI 1.18–2.74)
Elevated BNP (≥40 pg/mL) is independently associated with incident cardiovascular disease events in the general Japanese population, an association partially mediated by blood pressure during sleep.
High BNP may flag higher CVD risk beyond sleep BP; leaves open its added value for routine risk stratification.
Background B-type natriuretic peptide (BNP) is a risk marker for not only heart failure but also cardiovascular diseases (CVD). This study investigated the possible mediating role of sleep blood pressure (BP) in the association between BNP and CVD events. Methods Data for 5,751 participants were obtained from the Nagahama Study, a longitudinal cohort study of the general Japanese population. Circulating BNP levels were determined from blood specimens. BP was measured at home in the morning and evening, and three times per night during sleep using a timer-equipped cuff-oscillometric device. Results During the mean follow-up period of 9.4 years (54,350 person-years), 169 CVD cases were observed (Incidence rate: 31.1 per 10,000 person-year, 95% confidence interval [CI]: 26.7, 36.2). BNP levels ≥40 pg/mL were independently associated with CVD. The sleep BP-adjusted hazard ratio of high BNP for CVD was 1.80 (95% CI: 1.18, 2.74), while the awake home BP-adjusted hazard ratio was 1.92 (95% CI: 1.26, 2.91). Causal mediation analysis indicated a greater mediation rate of sleep SBP (14.3%, 95% CI: −2.8, 31.3) than awake home SBP (5.8%, 95% CI; −2.6, 14.2) in the association between BNP and CVD incidence. Factors associated with log-normalized BNP levels were age, sex, body mass index, sleep SBP, and nocturnal urination frequency. Conclusion Prognostic significance of BNP for CVD events was partially mediated by BP particularly BP during sleep.
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Tabara et al. (2026) conducted a cohort in Cardiovascular diseases (n=5,751). High B-type natriuretic peptide (BNP ≥40 pg/mL) vs. BNP <40 pg/mL was evaluated on Cardiovascular disease (CVD) events (HR 1.80, 95% CI 1.18-2.74). High BNP (≥40 pg/mL) was associated with increased CVD events (sleep BP-adjusted HR 1.80; 95% CI 1.18-2.74), partially mediated by sleep SBP (14.3%).
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