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(Circulation. 2008;117:1685-1692.)
© 2008 American Heart Association, Inc.

Hypertension

N-Terminal Prohormone Brain Natriuretic Peptide as a Predictor of Cardiovascular Disease and Mortality in Blacks With Hypertensive Kidney Disease

The African American Study of Kidney Disease and Hypertension (AASK)

B.C. Astor, PhD; S. Yi, MPH; L. Hiremath, PhD; T. Corbin, MD; V. Pogue, MD; B. Wilkening, PA-C; G. Peterson, MD; J. Lewis, MD; J.P. Lash, MD; F. Van Lente, PhD; J. Gassman, PhD; X. Wang, PhD; G. Bakris, MD; L.J. Appel, MD; G. Contreras, MD

From the Welch Center for Prevention, Epidemiology and Clinical Research (B.C.A., S.Y., L.J.A.), Department of Epidemiology (B.C.A., S.Y., L.J.A.), and Division of General Internal Medicine, Department of Medicine (B.C.A., L.J.A.), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Nephrology (L.H.), Ohio State University, Columbus; Division of Internal Medicine, Department of Medicine (T.C.), University of Michigan, Ann Arbor; Department of Medicine (V.P.), Harlem Hospital Center, New York, NY; Department of Medicine, Renal Division (B.W.), Emory University, Atlanta, Ga; Department of Internal Medicine (G.P.), University of Texas Southwestern Medical Center, Dallas; Nephrology Division (J.L.), Vanderbilt University, Nashville, Tenn; Section of Nephrology (J.P.L.), University of Illinois at Chicago, Chicago; Department of Clinical Pathology and Department of Nephrology and Hypertension (F.V.L.), and Department of Quantitative Health Sciences (J.G., X.W.), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Medicine (G.B.), University of Chicago Pritzker School of Medicine, Chicago Ill; and Department of Medicine, Division of Nephrology and Hypertension (G.C.), Miller School of Medicine, University of Miami, Miami, Fla.

Correspondence to Brad C. Astor, PhD, MPH, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E Monument St, Suite 2-600, Baltimore, MD 21205. E-mail bastor{at}jhsph.edu

Received July 2, 2007; accepted January 11, 2008.

Background— Higher levels of N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) predict cardiovascular disease (CVD) in several disease states, but few data are available in patients with chronic kidney disease or in blacks.

Methods and Results— The African American Study of Kidney Disease and Hypertension trial enrolled hypertensive blacks with a glomerular filtration rate of 20 to 65 mL · min^–1 · 1.73 m^–2 and no other identified cause of kidney disease. NT-proBNP was measured with a sandwich chemiluminescence immunoassay (coefficient of variation 2.9%) in 994 African American Study of Kidney Disease and Hypertension participants. NT-proBNP was categorized as undetectable, low, moderate, or high. Proteinuria was defined as 24-hour urinary protein–creatinine ratio >0.22. A total of 134 first CVD events (CVD death or hospitalization for coronary artery disease, heart failure, or stroke) occurred over a median of 4.3 years. Participants with high NT-proBNP were much more likely to have a CVD event than participants with undetectable NT-proBNP after adjustment (relative hazard 4.0 [95% confidence interval [CI] 2.1 to 7.6]). A doubling of NT-proBNP was associated with a relative hazard of 1.3 (95% CI 1.0 to 1.6) for coronary artery disease, 1.7 (95% CI 1.4 to 2.2) for heart failure, 1.1 (95% CI 0.9 to 1.4) for stroke, and 1.8 (95% CI 1.4 to 2.4) for CVD death. The association of NT-proBNP with CVD events was significantly stronger (P_interaction=0.05) in participants with than in those without proteinuria. Higher NT-proBNP was not associated with renal disease progression.

Conclusions— These results suggest that elevated NT-proBNP levels are associated with higher CVD risk among blacks with hypertensive kidney disease. This association may be stronger in individuals with significant proteinuria.

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Circulation 2008 117: 1621. [Full Text]