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. (2013) conducted an 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.