N-terminal prob-type natriuretic peptide is a marker of vascular remodelling and subclinical atherosclerosis in asymptomatic hypertensives

作者：Pastormerlo Luigi E^*; Maffei Stefano; Della Latta Daniele; Chubuchny Vladislav; Susini Carla; Berti Sergio; Clerico Aldo; Prontera Concetta; Passino Claudio; Januzzi James L Jr; Emdin Michele; Chiappino Dante

来源：European Journal of Preventive Cardiology, 2016, 23(4): 366-376.

DOI：10.1177/2047487315569675

• Arterial hypertension
• natriuretic peptide
• subclinical atherosclerosis

Background Arterial hypertension is a main determinant of arterial remodelling and atherosclerosis. Coronary artery calcium score and carotid intima-media thickness are recognized indices of vascular remodelling. Established biohumoral markers for the diagnosis of atherosclerosis are still lacking in asymptomatic subjects with hypertension.
Objectives We aimed to test the association of plasma N-terminal pro B-type natriuretic peptide concentrations with either coronary artery calcium score or carotid intima-media thickness in asymptomatic hypertensive subjects.
Methods We conducted a case-control study on 436 hypertensi.ve and 436 age/sex-matched normotensive subjects from the population of the Montignoso HEart and Lung Project, a community-based study of asymptomatic general population 45 years. Subjects underwent N-terminal pro B-type natriuretic peptide measurement, echocardiography and evaluation of coronary artery calcium score and carotid intima-media thickness.
Results Hypertensive subjects had higher median coronary artery calcium score (60 (interquartile range, 30-112) vs. 15 (interquartile range 3-70) Agatson units, p=0.007), carotid intima-media thickness (8.6 (interquartile range 7.5-9.1) vs. 7.9 (7.1-8.4) mu m, p<0.001) and indexed left ventricular mass (101 (interquartile range 82-126) vs. 87 (63-91) mg/m2, p=0.03) than controls, with no differences in left ventricular ejection fraction, diameters, E/E, left atrial area. N-terminal pro B-type natriuretic peptide concentrations were higher in hypertensive subjects with either coronary artery calcium score (p=0.008) or carotid intima-media thickness >75th (p<0.006) percentile and highest in combined coronary artery calcium score/carotid intima-media thickness >75th percentile (p=0.021). In multivariable analysis, N-terminal pro B-type natriuretic peptide independently predicted either coronary artery calcium score or carotid intima-media thickness >75th percentile, but only in hypertensive subjects (odds ratio=1.87, 95% confidence interval 1.30-2.74, p=0.001 and odds ratio=1.99, 95% confidence interval 1.43-2.76, p=0.001).
Conclusions In asymptomatic subjects with hypertension, N-terminal pro B-type natriuretic peptide is a marker of hypertension-mediated preclinical vascular disease.

• 出版日期2016-3