Perindopril-based blood pressure-lowering therapy reduces amino-terminal-pro-B-type natriuretic peptide in individuals with cerebrovascular disease.

Abstract

OBJECTIVE:

The plasma amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) level predicted congestive heart failure, myocardial infarction, and ischaemic stroke in participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a placebo-controlled study of the effects of blood pressure lowering on cardiovascular events among individuals with cerebrovascular disease. Active treatment comprised a flexible regimen based on perindopril, with the addition of indapamide at the discretion of treating physicians. Active treatment reduced cardiovascular events, and we therefore investigated whether active treatment modified NT-proBNP and other cardiovascular risk factors.

METHODS:

We measured NT-proBNP and other cardiovascular risk factors at randomization and after 13 months of therapy in a subset of 357 PROGRESS participants.

RESULTS:

Baseline systolic and pulse pressures were higher in individuals with elevated baseline NT-proBNP levels. In comparison with placebo, active treatment reduced the blood pressure and NT-proBNP levels, and increased renin levels. Reduction of NT-proBNP levels by active treatment was most evident in individuals with baseline NT-proBNP levels in the highest quarter (> 26 pmol/l), with a median reduction of 16 pmol/l (interquartile range 0-51 pmol/l, P = 0.004), corresponding to a median decrease of 39% (interquartile range 0-69%). Active treatment reduced blood pressure similarly for individuals in each of the four quarters of baseline NT-proBNP. Active therapy had no effect on plasma lipid, C-reactive protein, homocysteine, or soluble vascular cell adhesion molecule 1 levels.

CONCLUSION:

We conclude that plasma NT-proBNP level, in addition to predicting cardiovascular risk, may provide a measure of risk reduction by blood pressure-lowering therapy.

• Authors: Duncan J Campbell, Mark Woodward, John P Chalmers, Samuel A Colman, Alicia J Jenkins, Bruce E Kemp, Bruce C Neal, Anushka Patel, Stephen W MacMahon
• Journal: Journal of hypertension (J Hypertens) Vol. 25 Issue 3 Pg. 699-705 (Mar 2007) ISSN: 0263-6352 [Print] Netherlands
• PMID: 17278987 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Perindopril

Topics

• Aged
• Antihypertensive Agents (pharmacology)
• Biomarkers
• Blood Pressure (drug effects)
• Cardiovascular Diseases (prevention & control)
• Cerebrovascular Disorders (complications, prevention & control)
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood, drug effects)
• Peptide Fragments (blood, drug effects)
• Perindopril (pharmacology)
• Risk Factors