Kohno M, Horio T, Yokokawa K, Yasunari K, Ikeda M, Minami M, Kurihara N, Takeda T
First Department of Internal Medicine, Osaka City University Medical School, Japan.
Am J Med. 1995 Mar;98(3):257-65. doi: 10.1016/S0002-9343(99)80372-6.
Secretion of brain natriuretic peptide (BNP), a cardiac hormone, is accelerated via hypertrophied ventricles in experimental hypertension. The present study examined whether regression of left ventricular (LV) hypertrophy by long-term treatment with an angiotensin-converting enzyme inhibitor (ACEI) affects plasma BNP concentration in patients with essential hypertension.
Thirty-one hypertensive patients with LV hypertrophy were treated with ACEI (16 with enalapril; 15 with lisinopril) for 1 year. Serial changes were recorded in LV mass index, LV systolic function, and plasma concentrations of BNP and atrial natriuretic peptide (ANP).
ACEI therapy significantly reduced LV mass index at 6 months, and more so at 1 year. Septal and posterior wall thicknesses were also reduced. Plasma BNP and ANP were markedly elevated at study entry, but only BNP levels correlated with LV mass index. Both peptide levels declined after 6 months, and this decline was enhanced at 1 year. There was a close relation between BNP decline and LV mass index reduction overall and with enalapril and lisinopril separately. Changes in ANP and in LV mass index were not related.
Long-term ACEI therapy can reduce elevated plasma BNP. In this study, changes in BNP reflected the magnitude of regression of LVH. Plasma BNP may be a useful marker for LVH during antihypertensive therapy in patients with essential hypertension and LVH.
脑钠肽（BNP）是一种心脏激素，在实验性高血压中，其分泌会通过肥厚的心室加速。本研究探讨了长期使用血管紧张素转换酶抑制剂（ACEI）治疗使左心室（LV）肥厚消退是否会影响原发性高血压患者的血浆BNP浓度。
31例患有LV肥厚的高血压患者接受ACEI治疗（16例使用依那普利；15例使用赖诺普利），为期1年。记录LV质量指数、LV收缩功能以及BNP和心房钠尿肽（ANP）血浆浓度的系列变化。
ACEI治疗在6个月时显著降低了LV质量指数，1年时降低更明显。室间隔和后壁厚度也有所减少。在研究开始时，血浆BNP和ANP显著升高，但只有BNP水平与LV质量指数相关。6个月后两种肽水平均下降，且在1年时这种下降更为明显。总体而言，BNP下降与LV质量指数降低密切相关，分别与依那普利和赖诺普利治疗也密切相关。ANP变化与LV质量指数变化无关。
长期ACEI治疗可降低升高的血浆BNP。在本研究中，BNP的变化反映了LVH消退的程度。血浆BNP可能是原发性高血压合并LVH患者降压治疗期间LVH的一个有用标志物。
