Mussalo Hanna, Vanninen Esko, Ikäheimo Risto, Hartikainen Juha
Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Kuopio, Kuopio, Finland.
Kidney Blood Press Res. 2003;26(1):34-41. doi: 10.1159/000069763.
BACKGROUND/AIMS: The plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) become increased in hypertension. However, it is unknown what is the effect of the etiology and the severity of hypertension on the plasma concentrations of ANP and BNP.
We examined plasma levels of ANP (measured as N-terminal fragment of proatrial natriuretic peptide; NT-proANP) and BNP in patients having sustained hypertension of different etiology and severity: in patients with renovascular hypertension (RVHT, n = 12), severe essential hypertension (SEHT, n = 37), and mild essential hypertension (MEHT, n = 29). In addition, we studied the diagnostic value of NT-proANP and BNP to discriminate patients with RVHT from patients with essential hypertension.
The plasma concentrations of NT-proANP and BNP were higher in the RVHT group (593 +/- 80 and 25.0 +/- 9.3 pmol/l, respectively) than in the SEHT group (320 +/- 33 and 4.7 + 0.6 pmol/l, respectively; p < 0.001 for both), in spite of the similar blood pressure level, and also higher than in the MEHT group (356 +/- 30 and 7.0 +/- 1.0 pmol/l; p = 0.004 and p = 0.006, respectively). There was no difference in natriuretic peptide levels between the SEHT and MEHT groups. Plasma NT-proANP and BNP correlated positively with aging and serum creatinine concentration and inversely with left ventricular diastolic filling. In addition, NT-proANP correlated positively with systolic blood pressure and BNP with left ventricular mass index. The areas under receiver operating characteristic curves for plasma NT-proANP and BNP to discriminate RVHT patients from patients with essential hypertension were 0.793 and 0.782, respectively. The best cutoff value was 530 pmol/l for NT-proANP, giving a sensitivity of 67% with a specificity of 86%. The cutoff value of 9.8 pmol/l for BNP resulted in a sensitivity of 58% and a specificity of 90%.
Patients with RVHT have higher plasma levels of NT-proANP and BNP than patients with essential hypertension. In addition to the etiology of hypertension, also left ventricular characteristics are important determinants of NT-proANP and BNP concentrations in hypertension. Due to the low sensitivity, NT-proANP and BNP are not suitable as screening tools for RVHT.
背景/目的：高血压患者的血浆心房钠尿肽（ANP）和脑钠尿肽（BNP）浓度会升高。然而，高血压的病因和严重程度对ANP和BNP血浆浓度的影响尚不清楚。
我们检测了不同病因和严重程度的持续性高血压患者的ANP（以前心房钠尿肽N端片段；NT-proANP测量）和BNP血浆水平：肾血管性高血压（RVHT，n = 12）、重度原发性高血压（SEHT，n = 37）和轻度原发性高血压（MEHT，n = 29）患者。此外，我们研究了NT-proANP和BNP对区分RVHT患者和原发性高血压患者的诊断价值。
尽管血压水平相似，但RVHT组的NT-proANP和BNP血浆浓度（分别为593±80和25.0±9.3 pmol/l）高于SEHT组（分别为320±33和4.7±0.6 pmol/l；两者p均<0.001），也高于MEHT组（356±30和7.0±1.0 pmol/l；分别为p = 0.004和p = 0.006）。SEHT组和MEHT组之间的利钠肽水平没有差异。血浆NT-proANP和BNP与年龄和血清肌酐浓度呈正相关，与左心室舒张充盈呈负相关。此外，NT-proANP与收缩压呈正相关，BNP与左心室质量指数呈正相关。血浆NT-proANP和BNP区分RVHT患者和原发性高血压患者的受试者工作特征曲线下面积分别为0.793和0.782。NT-proANP的最佳截断值为530 pmol/l，敏感性为67%，特异性为86%。BNP的截断值为9.8 pmol/l，敏感性为58%，特异性为90%。
RVHT患者的NT-proANP和BNP血浆水平高于原发性高血压患者。除高血压病因外，左心室特征也是高血压患者NT-proANP和BNP浓度的重要决定因素。由于敏感性较低，NT-proANP和BNP不适合作为RVHT的筛查工具。
