Cardiology Department, European Society of Hypertension excellence Center, Hôpital de la Croix Rousse, Service de Cardiologie, F-69004, Lyon Cedex, France.
Hypertension. 2011 Apr;57(4):702-9. doi: 10.1161/HYPERTENSIONAHA.110.163550. Epub 2011 Mar 7.
Natriuretic peptides are controregulatory hormones associated with cardiac remodeling, namely, left ventricular hypertrophy and systolic/diastolic dysfunction. We intended to address the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in hypertension. We prospectively studied the relationship between plasma NT-proBNP and all-cause mortality in 684 hypertensive patients with no history or symptoms of heart failure referred for hypertension workup in our institution from 1998 to 2008. After a mean duration of 5.7 years, we observed 40 deaths (1.04 deaths per 100 patients per year). After adjustment for traditional cardiovascular risk factors, including ambulatory blood pressure and serum creatinine, the risk for all-cause mortality more than doubled with each increment of 1 log NT-proBNP (hazard ratio: 2.33 [95% CI: 1.36 to 3.96]). The risk of death of patients with plasma NT-proBNP≥133 pg/mL (third tertile of the distribution) was 3.3 times that of patients with values<50.8 pg/mL (first tertile; hazard ratio: 3.30 [95% CI: 0.90 to 12.29]). This predictive value was independent of, and superior to, that of 2 ECG indexes of left ventricular hypertrophy, the Sokolov-Lyon index and the amplitude of the R wave in lead aVL. In addition, it persisted in patients without ECG left ventricular hypertrophy, which allowed refining risk stratification in this relatively low-risk patient category. In this large sample of hypertensive patients, plasma NT-proBNP appeared as a strong prognostic marker. This performance, together with the ease of measurement, low cost, and widespread availability of NT-proBNP test kits, should prompt a wide use of this marker for risk stratification in hypertension.
利钠肽是与心脏重构相关的控制调节激素，即左心室肥厚和收缩/舒张功能障碍。我们旨在探讨 N 末端脑利钠肽前体（NT-proBNP）在高血压中的预后价值。我们前瞻性研究了血浆 NT-proBNP 与我院 1998 年至 2008 年间因高血压就诊且无心力衰竭病史或症状的 684 例高血压患者全因死亡率之间的关系。平均随访 5.7 年后，我们观察到 40 例死亡（1.04 例/100 例患者/年）。在校正包括动态血压和血清肌酐在内的传统心血管危险因素后，NT-proBNP 每增加 1 个对数单位，全因死亡率的风险增加一倍以上（危险比：2.33[95%可信区间：1.36 至 3.96]）。血浆 NT-proBNP≥133pg/mL（分布的第三 tertile）患者的死亡风险是 NT-proBNP<50.8pg/mL（第一 tertile）患者的 3.3 倍（危险比：3.30[95%可信区间：0.90 至 12.29]）。这种预测价值独立于并优于两个左心室肥厚的心电图指数（Sokolov-Lyon 指数和 aVL 导联 R 波振幅）。此外，它在无心电图左心室肥厚的患者中仍然存在，这使得在这个相对低风险的患者类别中能够进行更精细的风险分层。在这个大型高血压患者样本中，血浆 NT-proBNP 似乎是一个强大的预后标志物。这种表现，加上测量的简便性、成本低廉和 NT-proBNP 试剂盒的广泛可用性，应该促使广泛使用该标志物进行高血压的风险分层。
