Pahle Andreas S, Sørli Daniel, Omland Torbjørn, Knudsen Cathrine Wold, Westheim Arne, Wu Alan H B, Steg Philippe Gabriel, McCord James, Nowak Richard M, Hollander Judd E, Storrow Alan B, Abraham William T, McCullough Peter A, Maisel Alan
Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Am J Cardiol. 2009 Oct 1;104(7):966-71. doi: 10.1016/j.amjcard.2009.05.039.
Hypertension may affect the diagnostic performance of B-type natriuretic peptide (BNP). The objective of the present study was to assess the impact of a history of hypertension or blood pressure elevation on admission on the diagnostic performance of BNP in the diagnosis of heart failure (HF) in patients with acute dyspnea. BNP levels were measured using a rapid point-of-care device in 1,586 patients with acute dyspnea. In patients with HF, BNP levels did not differ between those with and without histories of hypertension. Conversely, in patients without HF, a history of hypertension was associated with higher median BNP levels (38 pg/ml [interquartile range 13 to 119] vs 21 pg/ml [interquartile range 7 to 64], p <0.001). The areas under the receiver-operating characteristic curves were 0.88 and 0.93 for those with and without histories of hypertension, respectively (p <0.001). Blood pressure elevation on admission did not affect the diagnostic accuracy of BNP (areas under the curve 0.90 in the 2 groups). In conclusion, although a history of hypertension is associated with higher BNP levels in patients with acute dyspnea without HF, the impact on the overall diagnostic performance of BNP is modest. Accordingly, BNP performs well as an indicator of HF in patients presenting in emergency departments regardless of a history of hypertension or elevated blood pressure on admission.
高血压可能会影响B型利钠肽（BNP）的诊断性能。本研究的目的是评估高血压病史或入院时血压升高对急性呼吸困难患者中BNP诊断心力衰竭（HF）的诊断性能的影响。使用即时快速检测设备对1586例急性呼吸困难患者进行BNP水平检测。在HF患者中，有高血压病史和无高血压病史的患者BNP水平无差异。相反，在无HF的患者中，高血压病史与较高的BNP中位数水平相关（38 pg/ml[四分位数间距13至119] vs 21 pg/ml[四分位数间距7至64]，p<0.001）。有高血压病史和无高血压病史的患者，其受试者工作特征曲线下面积分别为0.88和0.93（p<0.001）。入院时血压升高并不影响BNP的诊断准确性（两组曲线下面积均为0.90）。总之，虽然高血压病史与无HF的急性呼吸困难患者较高的BNP水平相关，但对BNP总体诊断性能的影响较小。因此，无论患者有无高血压病史或入院时血压升高，BNP作为急诊科患者HF的指标表现良好。
