Skip to main content
PMC home page
Heart logoLink to Heart
. 2000 Mar;83(3):278–282. doi: 10.1136/heart.83.3.278

Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunction on plasma N terminal proBNP

S Talwar 1, A Siebenhofer 1, B Williams 1, L Ng 1
PMCID: PMC1729338  PMID: 10677405

Abstract

OBJECTIVES—To examine the relation between plasma concentration of the N terminal of the precursor of brain natriuretic peptide (NT proBNP), left ventricular hypertrophy (LVH), and left ventricular systolic dysfunction (LVSD) in patients with a history of hypertension.
DESIGN—Prospective study.
SETTING—Teaching hospital based study.
PATIENTS—NT proBNP concentrations were determined in five groups of individuals. Group 1: 15 echocardiographic normal controls; group 2: 22 patients with hypertension, normal left ventricular systolic function, and no LVH; group 3: 24 patients with hypertension, normal left ventricular systolic function, and LVH; group 4: 13 patients with history of hypertension, no history of ischaemic heart disease, and left ventricular wall motion index (WMI) between 1.9-1.3; and group 5:17 patients with a history of hypertension, no history of ischaemic heart disease, and WMI < 1.2.
RESULTS— Median (range) NT proBNP concentrations (in fmol/ml) for groups 1-5, respectively, were: 129.4 (53.6-159.7), 147.4 (54.3-730.5), 137.1 (35.8-403.9), 356.7 (124.4-934.4), and 493.5 (248.9-909). Mean log NT proBNP differed among all five groups (p < 0.0001), and between groups 4 and 5 versus groups 1-3 (p < 0.0001), and group 4 versus group 5 (p = 0.02) only.
CONCLUSIONS—The results suggest that the presence of hypertension with or without LVH (and normal left ventricular systolic function) does not affect NT proBNP concentrations. Moreover, there is a significant rise in NT proBNP only when LVSD develops in hypertension. Thus, NT proBNP remains a useful diagnostic aid for LVSD, even in hypertensive patients.


Keywords: hypertension; brain natriuretic peptide; left ventricular hypertrophy; left ventricular systolic dysfunction; chemiluminescence

Full Text

The Full Text of this article is available as a PDF (117.8 KB).

Figure 1  .

Figure 1  

Open in a new tab

Box plot showing the relation between log NT proBNP concentrations and echocardiographic normal controls (group 1), patients with hypertension, normal left ventricular systolic function, and no LVH (group 2), patients with hypertension, normal left ventricular systolic function, and LVH (group 3), patients with a history of hypertension and left WMI between 1.9-1.3 (group 4), and patients with a history of hypertension and WMI of < 1.2 (group 5).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berning J., Rokkedal Nielsen J., Launbjerg J., Fogh J., Mickley H., Andersen P. E. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis. Cardiology. 1992;80(3-4):257–266. doi: 10.1159/000175011. [DOI] [PubMed] [Google Scholar]
  2. Berning J., Steensgaard-Hansen F. Early estimation of risk by echocardiographic determination of wall motion index in an unselected population with acute myocardial infarction. Am J Cardiol. 1990 Mar 1;65(9):567–576. doi: 10.1016/0002-9149(90)91032-2. [DOI] [PubMed] [Google Scholar]
  3. Buckley M. G., Markandu N. D., Miller M. A., Sagnella G. A., MacGregor G. A. Plasma concentrations and comparisons of brain and atrial natriuretic peptide in normal subjects and in patients with essential hypertension. J Hum Hypertens. 1993 Jun;7(3):245–250. [PubMed] [Google Scholar]
  4. Cheung B. M. Plasma concentration of brain natriuretic peptide is related to diastolic function in hypertension. Clin Exp Pharmacol Physiol. 1997 Dec;24(12):966–968. doi: 10.1111/j.1440-1681.1997.tb02729.x. [DOI] [PubMed] [Google Scholar]
  5. Devereux R. B., Casale P. N., Eisenberg R. R., Miller D. H., Kligfield P. Electrocardiographic detection of left ventricular hypertrophy using echocardiographic determination of left ventricular mass as the reference standard. Comparison of standard criteria, computer diagnosis and physician interpretation. J Am Coll Cardiol. 1984 Jan;3(1):82–87. doi: 10.1016/s0735-1097(84)80433-7. [DOI] [PubMed] [Google Scholar]
  6. Devereux R. B., Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977 Apr;55(4):613–618. doi: 10.1161/01.cir.55.4.613. [DOI] [PubMed] [Google Scholar]
  7. Frohlich E. D., Apstein C., Chobanian A. V., Devereux R. B., Dustan H. P., Dzau V., Fauad-Tarazi F., Horan M. J., Marcus M., Massie B. The heart in hypertension. N Engl J Med. 1992 Oct 1;327(14):998–1008. doi: 10.1056/NEJM199210013271406. [DOI] [PubMed] [Google Scholar]
  8. Hughes D., Talwar S., Squire I. B., Davies J. E., Ng L. L. An immunoluminometric assay for N-terminal pro-brain natriuretic peptide: development of a test for left ventricular dysfunction. Clin Sci (Lond) 1999 Apr;96(4):373–380. [PubMed] [Google Scholar]
  9. Hunt P. J., Richards A. M., Nicholls M. G., Yandle T. G., Doughty R. N., Espiner E. A. Immunoreactive amino-terminal pro-brain natriuretic peptide (NT-PROBNP): a new marker of cardiac impairment. Clin Endocrinol (Oxf) 1997 Sep;47(3):287–296. doi: 10.1046/j.1365-2265.1997.2361058.x. [DOI] [PubMed] [Google Scholar]
  10. Hunt P. J., Yandle T. G., Nicholls M. G., Richards A. M., Espiner E. A. The amino-terminal portion of pro-brain natriuretic peptide (Pro-BNP) circulates in human plasma. Biochem Biophys Res Commun. 1995 Sep 25;214(3):1175–1183. doi: 10.1006/bbrc.1995.2410. [DOI] [PubMed] [Google Scholar]
  11. Kohno M., Horio T., Yokokawa K., Murakawa K., Yasunari K., Akioka K., Tahara A., Toda I., Takeuchi K., Kurihara N. Brain natriuretic peptide as a cardiac hormone in essential hypertension. Am J Med. 1992 Jan;92(1):29–34. doi: 10.1016/0002-9343(92)90011-y. [DOI] [PubMed] [Google Scholar]
  12. Kohno M., Yokokawa K., Yasunari K., Kano H., Minami M., Hanehira T., Yoshikawa J. Changes in plasma cardiac natriuretic peptides concentrations during 1 year treatment with angiotensin-converting enzyme inhibitor in elderly hypertensive patients with left ventricular hypertrophy. Int J Clin Pharmacol Ther. 1997 Jan;35(1):38–42. [PubMed] [Google Scholar]
  13. Køber L., Torp-Pedersen C., Carlsen J., Videbaek R., Egeblad H. An echocardiographic method for selecting high risk patients shortly after acute myocardial infarction, for inclusion in multi-centre studies (as used in the TRACE study). TRAndolapril Cardiac Evaluation. Eur Heart J. 1994 Dec;15(12):1616–1620. doi: 10.1093/oxfordjournals.eurheartj.a060443. [DOI] [PubMed] [Google Scholar]
  14. Levy D., Garrison R. J., Savage D. D., Kannel W. B., Castelli W. P. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990 May 31;322(22):1561–1566. doi: 10.1056/NEJM199005313222203. [DOI] [PubMed] [Google Scholar]
  15. Mukoyama M., Nakao K., Saito Y., Ogawa Y., Hosoda K., Suga S., Shirakami G., Jougasaki M., Imura H. Human brain natriuretic peptide, a novel cardiac hormone. Lancet. 1990 Mar 31;335(8692):801–802. doi: 10.1016/0140-6736(90)90925-u. [DOI] [PubMed] [Google Scholar]
  16. Nishikimi T., Yoshihara F., Morimoto A., Ishikawa K., Ishimitsu T., Saito Y., Kangawa K., Matsuo H., Omae T., Matsuoka H. Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension. Hypertension. 1996 Jul;28(1):22–30. doi: 10.1161/01.hyp.28.1.22. [DOI] [PubMed] [Google Scholar]
  17. Omland T., Aakvaag A., Bonarjee V. V., Caidahl K., Lie R. T., Nilsen D. W., Sundsfjord J. A., Dickstein K. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation. 1996 Jun 1;93(11):1963–1969. doi: 10.1161/01.cir.93.11.1963. [DOI] [PubMed] [Google Scholar]
  18. Richards A. M., Nicholls M. G., Yandle T. G., Frampton C., Espiner E. A., Turner J. G., Buttimore R. C., Lainchbury J. G., Elliott J. M., Ikram H. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Circulation. 1998 May 19;97(19):1921–1929. doi: 10.1161/01.cir.97.19.1921. [DOI] [PubMed] [Google Scholar]
  19. Rifkin R. D., Koito H. Comparison with radionuclide angiography of two new geometric and four nongeometric models for echocardiographic estimation of left ventricular ejection fraction using segmental wall motion scoring. Am J Cardiol. 1990 Jun 15;65(22):1485–1490. doi: 10.1016/0002-9149(90)91360-i. [DOI] [PubMed] [Google Scholar]
  20. Sahn D. J., DeMaria A., Kisslo J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978 Dec;58(6):1072–1083. doi: 10.1161/01.cir.58.6.1072. [DOI] [PubMed] [Google Scholar]
  21. Tateyama H., Hino J., Minamino N., Kangawa K., Ogihara T., Matsuo H. Characterization of immunoreactive brain natriuretic peptide in human cardiac atrium. Biochem Biophys Res Commun. 1990 Feb 14;166(3):1080–1087. doi: 10.1016/0006-291x(90)90977-u. [DOI] [PubMed] [Google Scholar]
  22. Yandle T. G., Richards A. M., Gilbert A., Fisher S., Holmes S., Espiner E. A. Assay of brain natriuretic peptide (BNP) in human plasma: evidence for high molecular weight BNP as a major plasma component in heart failure. J Clin Endocrinol Metab. 1993 Apr;76(4):832–838. doi: 10.1210/jcem.76.4.8473392. [DOI] [PubMed] [Google Scholar]
  23. Yoshimura M., Yasue H., Okumura K., Ogawa H., Jougasaki M., Mukoyama M., Nakao K., Imura H. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation. 1993 Feb;87(2):464–469. doi: 10.1161/01.cir.87.2.464. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES