N-terminal pro-brain natriuretic peptide in arterial hypertension: A valuable prognostic marker of cardiovascular events

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) provides important prognostic information in patients with chronic heart failure and in the general population. The aim of this study was to evaluate NT-proBNP as a prognostic marker of cardiovascular morbidity and death in a sample of subjects with hypertension and preserved left ventricular systolic function from the general population. Methods and Results: The study population was recruited from 4 general practitioners. The study participants (n = 569 subjects; ages, 50-89 years) completed a heart failure questionnaire and were submitted to blood pressure measurement, electrocardiography, echocardiography, and blood sampling. After exclusion of subjects with left ventricular ejection fraction of < 50%, 270 subjects fulfilled the following criteria for hypertension: history of hypertension or blood pressure > 150/90 mm Hg. During 3 years of follow-up, 28 subjects (10.4%) reached the composite end point of death, stroke/transient ischemic attack, or myocardial infarction. After adjustment for cardiovascular risk factors, NT-proBNP (logarithmically transformed) independently predicted the risk of experiencing a composite end point (hazard ratio, 1.94; P < .0001), and death (hazard ratio, 2.28; P < .0001). The risk of having a composite end point (21 vs 7; P = .005) was significantly higher for subjects with NT-proBNP above the study median than for subjects with NT-proBNP below the study median. Conclusion: In this sample of subjects with hypertension and preserved left ventricular systolic function from the general population, plasma NT-proBNP was found to be a valuable cardiovascular risk marker, independently of traditional risk factors and prevalent cardiovascular disease.