Abstract P352: Is Brain Natriuretic Peptide or Pro- Brain Natriuretic Peptide of value for Early Cardiovascular Disease Risk Stratification in asymptomatic Subjects?

Abstract

Introduction: There has been much discussion in recent years about the use of Brain natriuretic peptide (BNP) or Pro-brain natriuretic peptide (Pro-BNP) for cardiovascular disease (CVD) risk stratification. The purpose of this study is to assess the association between the presence of abnormal BNP/pro BNP with Left ventricular Hypertrophy (LVH) in asymptomatic subjects with or without hypertension and their value for early CVD risk stratification. Methods: We evaluated 2230 subjects aged 23-80 years, who underwent screening for CVD risk using Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS). ECVDRS consists of 10 non-invasive tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (BP PME), Carotid Intima Media Thickness (CIMT), abdominal aorta ultrasound, retinal photography, microalbuminuria, electrocardiogram (ECG), left ventricular ultrasound, and BNP/Pro-BNP. Results: Among the 2230 asymptomatic participants, we analyzed 933 who were treated by at least one or more cardiovascular medication for Diabetes, Hypertension (HTN) or Hyperlipidemia. Our hypothesis was that asymptomatic subjects with LVH have a significantly higher BNP/ProBNP values than those without LVH independent of HTN management. We used 3 Chi-square tests to test the independence between the two groups (with or without LVH) regarding their BNP/ProBNP status for the whole sample and further stratified by their HTN control. The findings in three tests were highly significant; the proportion of abnormal LVH was 0.17 and 0.39 respectively with normal vs elevated BNP/ProBNP for the whole sample, χ 2 (1, N = 933) = 36.693, p < 0.001. When we stratified by HTN control, with uncontrolled HTN the proportion of abnormal LVH was 0.25 and 0.46 respectively with the normal vs elevated BNP/ProBNP, χ 2 (1, N = 271) = 11.983, p =0.0005. Among participants with controlled HTN the proportion of abnormal LVH was 0.15 and 0.33 respectively with normal vs elevated BNP/ProBNP, χ 2 (1, N = 662) = 18.257, p < 0.001. Conclusions: Abnormal BNP/pro-BNP levels are significantly associated with abnormal LVH findings in asymptomatic subjects independent of their HTN control. Thus, ProBNP/BNP could be considered an important follow up test for early detection of serious CV structural abnormality like LVH during the management of patients with HTN regardless of the degree of their HTN control. This finding may justify a more aggressive treatment approach and close monitoring with BNP/ProBNP as a possible screener for CVD manifestations like LVH in HTN patients.