Abstract
Concentrations of plasma N-terminal pro brain natriuretic peptide (NT-proBNP) is inversely related to metabolic cardiovascular risk factors and is a valuable prognostic marker of cardiovascular events in arterial hypertension. Whether NT-proBNP levels are connected with diastolic function and arterial function was determined in hypertension. NT-proBNP was measured in 40 untreated patients with hypertension (mean BP 166/96 mmHg) without heart failure and 20 age and gender matched healthy, controls. Hypertensive patients were studied by pulsed Doppler and color M-mode Doppler echocardiography to evaluate LV diastolic function. Plasma NT-proBNP was significantly elevated in patients with hypertension (75.1 ± 75.2 [SD] pg/ml compared with 37.9 ± 38.5 in controls p < 0.05). In hypertensive patients, NT-proBNP values were negatively correlated with the ratio of color M-mode flow propagation velocity to transmitral E velocity (r=−0.33, p<0.05) while those of BNP had no correlation, suggesting that higher plasma NT-proBNP is indicative of subclinical diastolic dysfunction. Moreover, hypertensive patients with higher NT-proBNP values above the mean value in the control group (NT-proBNP > 38 pg/ml) had significantly increased brachial intimal-medial thickness (0.36 ± 0.08 mm vs. 0.32 ± 0.05, p < 0.05) and reduced wall stress (112.4 ± 29.5 kPa vs. 142.2 ± 30.8, p < 0.05) compared with those with lower NT-proBNP, suggesting that the reference value of NT-proBNP plasma concentrations in uncomplicated hypertensives is 38pg/ml and higher NT-proBNP levels were associated with favorable remodeling of the peripheral arteries. Elevation of plasma NT-proBNP can be useful to identify subclinical LV diastolic dysfunction and peripheral arterial remodeling in asymptomatic patients with hypertension.
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