N-terminal Atrial Natriuretic Peptide Research Articles

BS O07 Short-Term and Long-Term Changes in Natriuretic Peptide Levels After Bariatric Surgery: A Meta-Analysis

Abstract Background Bariatric surgery (BS) has demonstrated cardiovascular benefits in patients and was previously proven to be associated with an increased natriuretic peptide level without cardiac dysfunction. However, new studies have emerged, which require us to re-examine the relationship and extent of the correlation between BS, weight loss, and cardiac natriuretic peptide levels. Methods A PRISMA-compliant systematic search was conducted across Medline, Cochrane, and Embase, until 15th February 2023. Primary outcomes include short- and long-term changes in B-type natriuretic peptide (BNP) and N-terminal pro BNP (NT-proBNP) post-BS. Secondary outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), atrial natriuretic peptide (ANP), N-Terminal atrial natriuretic peptide (NT-ANP), ejection fraction (EF) and left ventricular mass (LVM). Outcomes were pooled using the DerSimonian and Laird random effects model. Results Twenty-two studies with 1219 patients (33.2% Male, 45.5% gastric bypass surgery). Mean difference of short- and long-term NT-proBNP levels after BS were 52.88 pg/mL (95% CI, 21.30-84.46) and 50.42 pg/mL (95% CI, 28.18-72.67) respectively with a similar rise observed in BNP levels. Short-term NT-ANP levels significantly increased, but not in long-term ANP and short-term NT-ANP levels. There were no significant post-BS changes in EF but SBP, DBP and LVM significantly reduced. Subgroup analysis in NT-proBNP levels demonstrated a significant rise among patients with >30% BMI loss and a significant reduction in patients with <30% BMI loss. Conclusions BS is associated with increased natriuretic peptide levels in the absence of deteriorating cardiac function. Further studies should investigate its correlation with clinical symptoms, cardiac structural changes and the longitudinal risk of heart failure, enabling informed decision-making and tailored management strategies to optimize patient care and improve postoperative cardiac outcomes in the context of BS.

NT-proANP levels in peripheral and cardiac circulation.

Recent studies have reported an association between N-terminal atrial natriuretic peptide (NT-proANP) and the progression of atrial fibrillation (AF). However, NT-proANP levels in peripheral and cardiac circulation in AF patients and in non-AF individuals need to be defined. The aims of the current study are (1) to analyze NT-proANP levels in peripheral and cardiac circulation in AF patients and (2) to compare NT-proANP levels in individuals with and without AF. We recruited AF patients who were undergoing their first AF catheter ablation and non-AF individuals. Blood plasma samples taken from the femoral vein and the left atrium (LA) were collected before AF ablation in the AF patients and from the cubital vein in the non-AF controls. Low voltage areas (LVAs) were determined using high-density maps during catheter ablation and defined as < 0.5mV. The study included 189 AF patients (64 ± 10years, 59% male, 61% persistent AF, 30% LVAs) and 26 non-AF individuals (58 ± 10years, 50% male). Patients with AF were significantly older and had larger LA (p < 0.05). Compared to non-AF controls, peripheral and cardiac NT-proANP levels were significantly higher in AF patients without and with LVAs (median 5.4, 10.5, 14.8ng/ml, respectively, p < 0.001). In multivariable analysis, NT-proANP (OR 1.238, 95% CI 1.007-1.521, p = 0.043) remained significantly different between non-AF individuals and AF patients. In AF, NT-proANP levels were significantly higher in the cardiac blood samples than in the peripheral blood (median 13.0 versus 11.4ng/ml, p = 0.003). The ability to predict LVAs was modest when using cardiac NT-proANP (AUC 0.661) and peripheral NT-proANP (AUC 0.635), without statistical difference (p = 0.937). NT-proANP levels are higher in individuals with AF than in controls and are more pronounced in progressed AF. Elevated cardiac and peripheral NT-proANP levels similarly predict LVAs.

Comparison of N-terminal pro-atrial natriuretic peptide and three cardiac biomarkers for discriminatory ability of clinical stage in dogs with myxomatous mitral valve disease.

Plasma N-terminal pro-atrial natriuretic peptide (NT-proANP) concentration increases with progression of myxomatous mitral valve disease (MMVD) in dogs. This multicentre, prospective study compared plasma NT-proANP, N-terminal pro-brain natriuretic peptide (NT-proBNP), ANP, and cardiac troponin I (cTnI) concentrations in dogs with MMVD for their characteristics and discriminatory ability to detect cardiac dilatation and congestive heart failure (CHF). Thirty-six healthy dogs and 69 dogs with MMVD were included. Clinical variables were obtained via physical examination, thoracic radiography, and echocardiography. The discriminatory ability of each cardiac biomarker (CB) to determine the presence or absence of cardiac dilatation (event 1) and CHF (event 2) was evaluated using the receiver operating characteristic curves. Plasma NT-proANP, NT-proBNP, and ANP concentrations showed a significant association with the left atrium/aorta ratio (P<0.01). The area under the curve of plasma NT-proANP and NT-proBNP concentrations were 0.72 and 0.75, respectively in event1 and 0.72 and 0.76, respectively in event2. Plasma NT-proANP and NT-proBNP concentrations showed sensitivity 80.0 and 80.0%; specificity 67.6 and 64.7% in event1 (cutoff value; 8,497.81 pg/ml and 1,453.00 pmol/l, respectively) and sensitivity 85.7 and 81.0%; specificity 60.4 and 64.6% in event2 (cutoff value; 8,684.33 pg/ml and 1,772.00 pmol/l, respectively). In dogs with MMVD, plasma NT-proANP, NT-proBNP, and ANP concentrations increase with left atrial enlargement. Particularly, plasma NT-proANP and NT-proBNP concentrations appeared to be equally useful in the discriminatory ability to detect cardiac dilatation and CHF.

Impact of Snoring on the Cardiovascular System and its Treatment: Positive and Negative Effects of Continuous Positive Airway Pressure in Sleep Apnea.

Obstructive sleep apnea (OSA) is a common condition, and if not treated can be a significant risk factor for multiple comorbidities like hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The underlying pathophysiology involves coagulation and inflammatory pathways, including an overactive sympathetic nervous system. This ultimately causes hemodynamic changes and subclinical myocardial injuries. We reviewed the published literature about the impact of continuous positive airway pressure (CPAP) when used as a mode of treatment to reduce the OSA effects on cardiomyocytes. We found that the results were mixed, including both ill and good effects. The cardiac markers like N-terminal pro-brain natriuretic peptide (NT-proBNP) and atrial natriuretic peptide (ANP) were reduced, implying the decrease in the incidence of heart failure with CPAP treatment in a few of the studies. They also proved a significant decrease in harmful cardiovascular (CV) outcomes, while others concluded that CPAP therapy might be stressful on the heart, causing an elevation in cardiac troponin T levels. However, the impact on inflammatory markers is still indeterminate and needs more research in future.

A4190 Relationship between plasma N-terminal pro-atrial natriuretic peptide and Corin levels and disease severity in patients with pregnancy induced hypertension

Objectives: We investigate the plasma N-terminal atrial natriuretic peptide (NT-proANP) and corin in pregnancy induced hypertension (PIH) and studies the correlation between plasma NT-proANP/ corin levels and adverse events. Methods: A total of 77 PIH who admitted in hospital were enrolled. 48 normotensive pregnancies in the same gestational weeks were chosen as control. Clinical characteristics were collected. Plasma was collected for laboratory examination Results: NT-proANP and corin was significantly increased in PIH compared with control (P = 0.003 and P < 0.001). The association between plasma NT-proANP/corin and the adverse event demostrated that 1) In PIH, NT-proANP and corin were increased significantly in preterm compared with that in full-term birth (P < 0.001 and P = 0.023); 2) Weeks of gestation in PIH patients were dramatically reduced compared with control, and it was negative correlated to NT-proANP and corin (R = −0.487, P < 0.001 and R = −0.383, P = 0.000); 3) The weight of newborns in PIH was significantly lower than that in control, and it was negatively correlated with NT-proANP and corin (R = −0.487, P < 0.001 and R = −0.383, P = 0.001); 4) The APGARP score of PIH was significantly lower than that of control, and it was negatively correlated with NT-proANP (R = −0.359, P = 0.001). NT-proANP/Corin and target organ function demonstrated that 1) The eGFR of PIH was significantly lower than that of control (P < 0.001), and it was negatively correlated with NT-proANP and corin (R = −0.490, P < 0.001 and R = −0.415, P < 0.001); 2) The urinary protein in PIH was significantly increased than that in control (P < 0.001), and it was positively correlated with NT-proANP and corin (R = 0.386, P = 0.001 and R = 0.401, P < 0.001). Conclusion: The plasma NT-proANP and corin was increased in PIH, and both of them may associate with the severity of PIH.

The role of mitofilin in left ventricular hypertrophy in hemodialysis patients

Left ventricular hypertrophy (LVH) is a common abnormality in hemodialysis (HD) patients. Mitochondrial dysfunction contributes to the progression of LVH. As an inner mitochondrial membrane structural protein, mitofilin plays a key role in maintaining mitochondrial structure and function. The aim of this study was to investigate the relationship between mitofilin and LVH in HD patients. A total of 98 HD patients and 32 healthy controls were included in the study. Serum N-terminal proBNP (NT-proBNP), endothelin-1 (ET-1), and atrial natriuretic peptide (ANP) were examined. The protein level of mitofilin and the mitochondrial DNA (mtDNA) copy number were estimated in peripheral blood mononuclear cells (PBMCs). The left ventricle mass index (LVMI) was evaluated in all participants, and the interaction between these variables and the LVMI was assessed. The LVMI was positively correlated with the NT-proBNP, ET-1, and ANP levels, and it was negatively correlated with mtDNA copy number and mitofilin levels. Multiple regression analysis showed that the NT-proBNP, ET-1, and ANP levels as well as mitofilin levels and mtDNA copy number were associated with the LVMI. Although further research of these associations is needed, this result suggests that LVH may affect the levels of mitofilin in HD patients.

Evaluation of Serum Levels of N-terminal Pro Brain Natriuretic Peptide and Atrial Natriuretic Peptide in Neonates with Respiratory Distress

Background: Acute respiratory distress (ARD) is a critical respiratory failure due to lung injury of neonates leading to the clinical appearance of poor lung compliance. The aimed of the study was to evaluate the diagnostic values in differentiating respiratory from heart diseases with using of N-terminal pro brain natriuretic peptide (NT-pro BNP) and Atrial natriuretic peptide(ANP) in neonates. Material and Methods: Ninety neonates randomly collected from those who hospitalized in the neonate ward of the Ali Ebne abitalib Hospital, Zahedan, Iran .After taking blood samples ANP and NT pro Brian Natriuretic peptide using ELISA kit were measured. The separated serum was kept in -20 °C until BNP measurement. 250 μl of the patients’ serum was isolated to assess pro BNP level using ELISA kit (USA). Data were analyzed using SPSS- 20 with considering of P< 0.05. Results: NT pro-BNP level had the highest in cardiac patients and followed by respiratory. The level of NT pro-BNP for control neonates had the lowest. These levels had significant variation (P<0.05). The level of ANP had the lowest for the cardiac patients. ANP level had the lowest for the acyanotic. NT pro-BNP had the highest concentration in acyanotic patients and and had the second highest concentration in cyanotic. Respiratory diseases ranked in the third levels in concentration of pro-BNP. The level of NT pro-BNP had the lowest for controls. The analysis showed a significant difference in the level of NT pro-BNP (P<0.05). Conclusion: Many studies revealed that NT pro-BNP cannot be used as a tool for differentiation between cardiac and respiratory as a cause of respiratory distress during neonate, but the results of the present study showed that it would be good biomarker.

Concentration of Natriuretic Peptides in Patients Suffering from Idiopathic Arterial Hypertension and Left Ventricular Diastolic Dysfunction Confirmed by Echocardiography

Concentration of natriuretic peptides (NPs) in arterial hypertension (AH) patients is higher than that in healthy people. One of the first symptoms of left ventricular hypertrophy (LVH) is left ventricular diastolic dysfunction (LVDD). The aim of this study was to examine whether determination of NPs in blood can be a useful indicator of LVDD detection in idiopathic AH patients. The study was conducted on three groups of patients: group Ia, 19 patients (average age 57 ± 3) with eccentric hypertrophy; group Ib, 13 patients (59 ± 4) with concentric hypertrophy; group II, 33 patients (58 ± 4) without AH or LVH. In all groups, mitral inflow profile was evaluated with Doppler test to detect LVDD, blood flow in upper right pulmonary vein, and concentration of atrial natriuretic peptide (ANP), N-terminal ANP (N-ANP), brain natriuretic peptide (BNP), and N-terminal BNP (N-BNP). In group Ia, significant correlations were observed between the following pairs: ratio of maximum early to late mitral inflow and ANP; deceleration time of early mitral inflow speed and ANP; atrial contraction (AR) and ANP; atrial contraction (AR) and N-ANP; similarly, in group Ib, significant correlations were observed between the following: relative wall thickness and BNP; isovolumic relaxation time and BNP; AR and BNP; relative wall thickness and N-BNP; isovolumic relaxation time and N-BNP; AR and N-BNP.

Low Plasma Level of Atrial Natriuretic Peptide Predicts Development of Diabetes: The Prospective Malmö Diet and Cancer Study

The cardiac natriuretic peptides are involved in blood pressure regulation, and large cross-sectional studies have shown lower plasma levels of N-terminal pro-natriuretic peptide levels [N-terminal atrial natriuretic peptide (N-ANP) and N-terminal brain natriuretic peptide (N-BNP)] in patients with insulin resistance, obesity, and diabetes. In this study, we prospectively tested whether plasma levels of mid-regional ANP (MR-ANP) and N-BNP predict new-onset diabetes and long-term glucose progression. MR-ANP and N-BNP were measured in 1828 nondiabetic individuals of the Malmö Diet and Cancer cohort (mean age 60 yr; 61% women) who subsequently underwent a follow-up exam including an oral glucose tolerance test after a median follow-up time of 16 yr. Logistic regression was used to adjust for covariates. During follow-up, 301 subjects developed new-onset diabetes. After full multivariate adjustment, MR-ANP was significantly inversely associated with incident diabetes (OR = 0.85; 95% CI = 0.73-0.99; P = 0.034) but not N-BNP (OR = 0.92; 95% CI = 0.80-1.06; P = 0.262). In fully adjusted linear regression models, the progression of fasting glucose during follow-up was significantly inversely related to baseline levels of MR-ANP (P = 0.004) but not N-BNP (P = 0.129). Quartile analyses revealed that the overall association was mainly accounted for by excess risk of incident diabetes in subjects belonging to the lowest quartile of MR-ANP. After full adjustment, the odds ratio for incident diabetes in the bottom compared with the top quartile of MR-ANP was 1.65 (OR = 1.08-2.51, P = 0.019) and 1.43 (OR = 1.04-1.96, P = 0.027) compared with all other subjects. Low plasma levels of MR-ANP predict development of future diabetes and glucose progression over time, suggesting a causal role of ANP deficiency in diabetes development.

Decompensated Heart Failure Is Associated With Reduced Corin Levels and Decreased Cleavage of Pro–Atrial Natriuretic Peptide

By promoting salt and water excretion, the corin and the atrial natriuretic peptide (ANP) system should help to maintain fluid balance in heart failure. Yet, the development of fluid retention despite high levels of ANP-related peptides suggests that this compensatory system is limited. Levels of circulating corin (the pro-ANP-converting enzyme) and pro-ANP were measured in hospitalized patients with heart failure, using novel immunoassays. Patients (n=14) had severe heart failure (New York Heart Association class III-IV) with a median ejection fraction of 18% and median brain natriuretic peptide levels of 1940 pg/mL. In heart failure, median plasma corin levels were 7.6-fold lower than measured in plasma from 16 normal control subjects (180 versus 1368 pg/mL, P<0.01). In contrast, in patients with heart failure, levels of plasma N-terminal ANP peptides (N-ANP and pro-ANP) levels were markedly elevated (42.0 versus 7.5 ng/mL, P<0.01). Levels of uncleaved pro-ANP, measured by novel immunoassays, were significantly higher in patients with heart failure (P<0.01), suggesting that corin cleavage of pro-ANP was impaired. Median plasma levels of cyclic guanosine monophosphate were elevated in patients with heart failure (150.0 versus 7.6 pmol/mL, P<0.01), and plasma cyclic guanosine monophosphate levels positively correlated with the fractional amount of cleaved pro-ANP (r(s)=0.59, P<0.03) but not with levels of uncleaved pro-ANP, implying that the cellular response to ANP remained intact. Taken together, these data suggest that there may be patients for whom low corin levels and impaired pro-ANP cleavage contribute to acute decompensation.

Normal growth and intravascular volume status with good metabolic control during peritoneal dialysis in infancy

The most demanding patient population on peritoneal dialysis (PD) consists of children under 2 years of age. Their growth is inferior to that of older children and maintaining euvolemia is difficult, especially in anuric patients. In this prospective study reported here, we enrolled 21 patients <2 years of age (mean 0.59 years) at onset of PD and monitored their uremia parameters and evaluated their nutrition. Since no good instrument currently exists for estimating intravascular volume status, we used traditional blood pressure measurements, echocardiography, and N-terminal atrial natriuretic peptide measurements. Growth was compared with midparental height. Metabolic control was good. Long-term hypertension was seen in 43% of the patients, but left ventricular hypertrophy decreased during the study period. Mean weekly urea Kt/V was 3.38 ± 0.66 and creatinine clearance was 49 ± 20 L/week per 1.73 m2. Catch-up growth was documented in 57% of the patients during PD. However, these children did not attain their midparental height at the end of PD at a mean age of 1.71 years. Although favorable metabolic control and good growth were achieved during PD, these children lagged in term of their midparental height. We conclude that several instruments are needed for determining the management of intravascular volume status and that the control of calcium–phosphorus status is demanding.

Simultaneous N-ANP and ET-1 Profiling Better Predicts Modes of Death in Chronic Heart Failure

Background: Elevated neurohormones are associated with increased mortality risks in heart failure (HF). We investigated the strategy of simultaneous profiling using both N-ANP (N-terminal atrial natriuretic peptide) and ET-1 (endothelin-1), as compared to either alone, in predicting modes of death in chronic HF pts. Methods: We conducted extended follow-up on 345 NYHA II-IV HF pts and LVEF <40% enrolled in 7 trials/studies between 1996 and 2004 in Belgium. Neurohormones were collected at baseline, and primary causes of deaths were ascertained based on clinical records while blinded to neurohormonal data.

B-type natriuretic peptide is related to histological skeletal muscle abnormalities in patients with chronic heart failure

This study examined the potential association between skeletal muscle histological findings and circulating levels of N-terminal Atrial natriuretic peptide (NT-proANP) and N-terminal B-type natriuretic peptide (NT-proBNP) at rest and during exercise in patients with moderate chronic heart failure. We report a significant correlation between muscle fibre roundness, defined as ratio of fibre perimeter squared to fibre area, and plasma levels of N-BNP. This finding suggests that the degree of intrafibrillar edema is related to the secretion of NT-proBNP.

Cardiac troponin T during sickle cell crisis

This study examined the potential association between skeletal muscle histological findings and circulating levels of N-terminal Atrial natriuretic peptide (NT-proANP) and N-terminal B-type natriuretic peptide (NT-proBNP) at rest and during exercise in patients with moderate chronic heart failure. We report a significant correlation between muscle fibre roundness, defined as ratio of fibre perimeter squared to fibre area, and plasma levels of N-BNP. This finding suggests that the degree of intrafibrillar edema is related to the secretion of NT-proBNP. © 2008 Published by Elsevier Ireland Ltd.

Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies

The diagnostic value of natriuretic peptides in uremic cardiomyopathy has not been defined, nor has the effect of a hemodialysis (HD) session on peptides. We performed an observational study of 100 white adult outpatients in New York Heart Association class I-II, with neither diabetes nor ischemic heart disease, 50 of whom had idiopathic dilated cardiomyopathy (DCM) and 50 of whom had uremic cardiomyopathy and were undergoing HD. We measured plasma N-terminal proB-type natriuretic peptide (NT-proBNP), BNP, and atrial natriuretic peptide (ANP) both before and after a dialysis session. Doppler echocardiograms were evaluated. We performed multiple regression analysis on the logarithm of peptide concentrations using clinical, laboratory, and echocardio-Doppler data as explanatory variables. Mean peptide concentrations were higher in the HD group, with an HD:DCM ratio of 25 for NT-proBNP and 5 for BNP and ANP. Peptides were correlated with each other (r > 0.85). After HD, NT-proBNP significantly increased by 14%, BNP decreased by 17%, and ANP decreased by 56%. Predialysis concentrations correlated with postdialysis values (r > 0.85). A multiple regression equation significantly fitted the observed peptide concentrations, both pre- and postdialysis, using the same set of 4 variables: disease group (DCM or HD), diastolic pattern, left atrial volume, and body mass index. Renal dysfunction was a confounder for natriuretic peptides, which were present in higher concentrations in the uremic patients with milder cardiac dysfunction than in those with idiopathic DCM without renal dysfunction. Left diastolic function pattern and atrial volume were cardiac determinants of peptide concentrations in DCM and HD.

The diagnostic accuracy of different natriuretic peptides in the investigation of canine cardiac disease

We aimed to validate and determine the accuracy of a new sandwich ELISA for canine N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the discrimination of canine patients with cardiac disease from those with respiratory disease and to determine the effect of confounding variables on NT-proBNP concentrations. Validation studies for the new assay were undertaken. Concentrations of N-terminal atrial natriuretic peptide (NT-proANP) and NT-proBNP in both ethylenediaminetetraacetic acid (EDTA) plasma and serum were estimated in samples from 77 dogs at a laboratory blinded to the clinical status of the patient. The diagnostic accuracy of the each sample type and test was evaluated using receiver operating characteristic curves. The effect of age, gender and indicators of renal function was evaluated using a multivariate regression analysis. Concentrations of NT-proBNP in both serum and plasma accurately discriminated dogs with respiratory disease from those with cardiac disease, with an optimum cut-off concentration of 210 pmol/l. NT-proBNP concentrations were unaffected by sample type. Increasing creatinine concentration is associated with increasing concentration of NT-proBNP. Age and gender were not found to have significant effects on natriuretic peptide concentrations in this population. Canine NT-proBNP appears to be a useful marker of the presence of cardiac disease, although concentrations must be interpreted in the light of the patient's renal function.

Baseline and Serial Neurohormones in Patients With Congestive Heart Failure Treated With and Without Bucindolol: Results of the Neurohumoral Substudy of the Beta-Blocker Evaluation of Survival Study (BEST)

Background Serial neurohormones may serve as markers of efficacy of congestive heart failure (CHF) therapy. We measured serial plasma big-endothelin (Big-ET), ET-1, N-terminal atrial natriuretic peptide, and brain natriuretic peptide (BNP) in 206 patients randomized to bucindolol or placebo in Beta-Blocker Evaluation of Survival Trial (BEST). Methods and Results Neurohormones were measured at baseline and 3 and 12 months. At baseline, BNP and Big-ET levels were greater in New York Heart Association (NYHA) Class IV than in Class III patients (median 122 pg/mL versus 447 pg/mL, P = .001; and 20.0 pg/mL versus 9.9 pg/mL, P = .003), and in patients with left ventricular ejection fraction (LVEF) ≤20% compared with LVEF >20% (median 211 pg/mL versus 99.1 pg/mL; and 12.9 pg/mL versus 8.0 pg/mL, both P = .003). Big-ET and BNP were the strongest predictors of the composite end point of CHF hospitalization or death. LVEF at 12 months correlated inversely with 12-month BNP levels ( r = −0.41, P = .0001). Bucindolol had no effect on neurohormones except that bucindolol treated patients had lower Big-ET levels at 3 months than patients receiving placebo (median 9.1 pg/mL versus 10.9 pg/mL, P = .05). A decline in ET-1 was associated with increased risk of the composite endpoint. Conclusions Lack of effect of bucindolol on natriuretic peptide levels appears consistent with its overall lack of efficacy in BEST.

Associations of Plasma Natriuretic Peptide, Adrenomedullin, and Homocysteine Levels With Alterations in Arterial Stiffness

Increased arterial stiffness and higher plasma natriuretic peptide and homocysteine levels are associated with elevated risk for cardiovascular disease. Little is known about the relations of natriuretic peptides and homocysteine to arterial wall stiffness in the community. We assessed the relations of plasma N-terminal atrial natriuretic peptide, B-type natriuretic peptide, adrenomedullin, and homocysteine concentrations to arterial stiffness in participants in the Framingham Heart Study. Central pulse pressure, forward pressure wave, reflected pressure wave, carotid-femoral pulse wave velocity, and carotid-radial pulse wave velocity were assessed by tonometry in 1962 participants (mean age, 61 years; 56% women) in the Framingham Heart Study. Central systolic and diastolic blood pressures were 123/75 mm Hg in men and 119/66 mm Hg in women. After adjustment for age and clinical covariates, N-terminal atrial natriuretic peptide and B-type natriuretic peptide were associated with carotid-femoral pulse wave velocity (men: partial correlation, 0.069, P = 0.043 and r = 0.115, P < or = 0.001, respectively; women: r = -0.063, P = 0.037 and r = -0.062, P = 0.040), and carotid-radial pulse wave velocity (men: r = -0.090, P = 0.009 and r = -0.083, P < or = 0.015; women: r = -0.140, P < or = 0.001 and r = -0.104, P = 0.001, respectively). In men, N-terminal atrial natriuretic peptide and B-type natriuretic peptide also were associated with forward and reflected wave and carotid pulse pressure. In men, adrenomedullin was associated with mean arterial pressure (r = 0.089, P = 0.009), and homocysteine was associated with carotid-femoral pulse wave velocity (r = 0.072, P = 0.036), forward pressure (r = 0.079, P = 0.02), and central pulse pressure (r = 0.072, P = 0.035). Interaction tests indicated sex differences in the relations of several biomarkers to measures of arterial stiffness. Plasma natriuretic peptide, adrenomedullin, and homocysteine levels are associated with alterations in conduit vessel properties that differ in men and women.

Moderate salt restriction effectively lowers blood pressure and degree of salt sensitivity is related to baseline concentration of renin and N-terminal atrial natriuretic peptide in plasma

The effect of salt restriction on blood pressure is under intense debate. We tested the effect of 100 mmol salt reduction on ambulatory blood pressure (ABP) in 46 Swedish individuals, 39 of whom completed the study, using a double-blind, placebo-controlled, cross-over design. Furthermore, we tested whether the basal plasma concentration of renin or N-terminal atrial natriuretic peptide (Nt-proANP) predict the degree of salt sensitivity. Participants received all meals and drinks with a total daily NaCl content of 50 mmol during 8 weeks. In addition, NaCl capsules (100 mmol/day) and corresponding placebo capsules were administered for 4 weeks each in random order. ABP after high-salt intake (150 mmol/day) was compared with ABP after low-salt intake (50 mmol/day). Salt sensitivity was defined as the difference between 24-h systolic ABP at the high-salt versus the low-salt periods. Baseline renin and Nt-proANP were related to salt sensitivity. Lowering of salt intake from 150 to 50 mmol/day induced significant blood pressure reductions (mean reduction, 95% confidence interval) in systolic and diastolic 24-h ABP (5.8, 3.4-8.2 and 2.6, 0.91-4.4 mmHg), daytime ABP (5.5, 2.9-8.1 and 2.3, 0.42-4.1 mmHg) and night-time ABP (6.4, 3.5-9.3 and 3.4, 1.4-5.5 mmHg). Baseline ln(renin) correlated inversely with salt sensitivity (r = -0.50, P = 0.001) whereas baseline ln(Nt-proANP) correlated directly (r = 0.33, P = 0.04). Lowering of salt intake with 100 mmol/day induces clinically relevant ABP reductions. Renin and Nt-proANP, measured with individuals on their habitual diet, could be useful biomarkers to identify individuals with the greatest blood pressure-lowering benefit from reduced salt intake.

Exertional Changes in Circulating Cardiac Natriuretic Peptides in Patients with Suggested Coronary Artery Disease

We measured plasma brain natriuretic peptide (BNP) and N-terminal atrial natriuretic peptide (ANP) levels before and after exercise stress testing and correlated results with echocardiographic evidence of ischemia. Sixty patients with left ventricular ejection fraction greater than 50% referred for clinically indicated exercise echocardiogram were studied. Peptides were measured at rest and 5 minutes after symptom-limited exercise. Echocardiography was positive for ischemia in 19 (32%). With exercise, ANP level increased in all 60 patients (median at rest 2501 [799-6440]-3167 [977-8563] pg/mL after exercise [P < .0001]). BNP increased in 54 patients (90%) (19 [<3.9-213]-30 [<3.9-318] pg/mL [P < .0001]). In multivariable analysis, both exercise BNP level and exertional change in BNP were closely associated with rest BNP (P < .0001); both were also significantly associated with change in wall-motion score index and workload (P = .001 and P = .01, respectively). Exercise ANP was strongly related to rest level (P < .0001); change in ANP was related to workload (P < .0001). In patients with suggested coronary artery disease, exertional levels of BNP are influenced not only by development of stress-induced ischemia, but also by resting levels.