The value of N-terminal pro-B-type natriuretic peptide in determining antihypertensive benefit: observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).

Abstract

We investigated 3 hypotheses: (1) N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular disease events in patients with hypertension, (2) NT-proBNP is associated with blood pressure variability, and (3) NT-proBNP predicts benefit from antihypertensive regimens. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized a subset of 6549 patients at risk with no history of coronary heart disease to either atenolol-based or amlodipine-based blood pressure-lowering treatment. During 5.5 years of follow-up, 485 cardiovascular disease cases accrued and were matched with 1367 controls. Baseline and 6-month in-trial NT-proBNP were measured. The results show that NT-proBNP improves cardiovascular disease risk prediction beyond established predictors, continuous net reclassification improvement of 22.3% (P<0.0001). Furthermore, a 1-mm Hg increase in the SD of systolic blood pressure was associated with 2% higher baseline NT-proBNP in a multivariable regression analysis (P<0.0001). However, NT-proBNP predicted cardiovascular disease risk independently of blood pressure variation (odds ratio per SD increase in log NT-proBNP 1.24; 95% confidence interval, 1.06-1.45; P=0.007). Atenolol-based treatment led to a 69.6% increase in NT-proBNP at 6 months (P<0.0001). In contrast, amlodipine-based treatment reduced NT-proBNP by 36.5% (P<0.0001). Amlodipine recipients who achieved a 6-month NT-proBNP below the median (61 pg/mL) were at lower risk of cardiovascular disease when compared with those who did not (odds ratio, 0.58; 95% confidence interval, 0.37-0.91) after adjustment for confounders inclusive of baseline NT-proBNP and achieved blood pressure. If confirmed, these novel results suggest that NT-proBNP, as well as aiding cardiovascular disease risk assessment, may also help assess the efficacy of specific antihypertensive regimens. Further relevant studies seem warranted.

• Authors: Paul Welsh, Neil R Poulter, Choon L Chang, Peter S Sever, Naveed Sattar, ASCOT Investigators
• Journal: Hypertension (Dallas, Tex. : 1979) (Hypertension) Vol. 63 Issue 3 Pg. 507-13 (Mar 2014) ISSN: 1524-4563 [Electronic] United States
• PMID: 24324046 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

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

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Biomarkers (blood)
• Blood Pressure (drug effects)
• Female
• Follow-Up Studies
• Humans
• Hypertension (blood, drug therapy, epidemiology)
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Odds Ratio
• Peptide Fragments (blood)
• Prevalence
• Prognosis
• Protein Precursors
• Retrospective Studies
• Risk Assessment (methods)
• Risk Factors
• Scandinavian and Nordic Countries (epidemiology)
• Time Factors
• United Kingdom (epidemiology)