Related Experiment Videos
B-Type Natriuretic Peptide and Ventricular Dysfunction in the Prediction of Cardiovascular Events and Death in
Joe Gallagher1, Chris Watson2, Shuaiwei Zhou3
1School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Insights
B-type natriuretic peptide (BNP) levels are superior to echocardiography in predicting major adverse cardiovascular events and death in hypertensive patients. BNP significantly enhances risk prediction beyond established scores.
Area of Science:
- Cardiology
- Biomarkers
- Hypertension Research
Background:
- Global rise in hypertension prevalence and morbidity necessitates improved risk stratification.
- Echocardiography and risk scores are guideline-recommended but may require complementary biomarkers.
- Natriuretic peptides offer a potential avenue for enhanced cardiovascular risk assessment.
Purpose of the Study:
- To compare the predictive ability of echocardiography-derived ventricular dysfunction and B-type natriuretic peptide (BNP) levels for major adverse cardiovascular events (MACE) and death in hypertensive patients.
- To evaluate the utility of the Systematic COronary Risk Evaluation (SCORE) in predicting MACE and death within an uncomplicated hypertensive cohort.
- To assess the added predictive value of BNP to existing risk scores.
Main Methods:
- Analysis of the screening to prevent heart failure cohort, including participants with and without prior cardiovascular events.
- Assessment of baseline ventricular dysfunction via echocardiography and plasma BNP levels.
- Utilized univariate and multivariate analyses, including likelihood ratios and net reclassification improvement, to evaluate predictive performance.
Main Results:
- B-type natriuretic peptide (BNP) was a significant predictor of MACE and death across all hypertensive groups.
- Ventricular dysfunction on echocardiography did not predict MACE or death.
- BNP demonstrated a stronger association with adverse events and significantly improved the predictive value of the SCORE risk assessment.
Conclusions:
- BNP is a superior biomarker to echocardiography for predicting MACE and death in both complicated and uncomplicated hypertensive patients.
- BNP provides significant incremental prognostic information, enhancing risk stratification beyond current methods.
- These findings support the integration of BNP testing into routine hypertension management for improved cardiovascular risk assessment.
Background:
The prevalence and morbidity of hypertension continues to grow globally and improved methods of stratifying risk and identifying organ damage earlier are required. Methods such as echocardiography and population-based risk scores are suggested by guidelines as approaches to aid in risk stratification. However, biomarkers such as natriuretic peptides may help provide such an approach.
Methods:
We analyzed data from the screening to prevent heart failure cohort including participants with hypertension with and without a history of a cardiovascular (CV) event at baseline. We investigated the ability of ventricular dysfunction on echocardiography at baseline and of B-type natriuretic peptide (BNP) levels in predicting future major adverse CV events (MACE) and death. We also investigated the use of Systematic COronary Risk Evaluation (SCORE) to predict these events in the uncomplicated cohort.
Results:
In total, 572 patients (427 with uncomplicated hypertension) were included. Thirty-three patients had MACE or died during follow up. In a univariate analysis, BNP was predictive of MACE and death in all groups. Ventricular dysfunction was not predictive of MACE and death in any group. Both BNP and SCORE had predictive value in this category. However, the magnitude and strength of the continuous association between BNP and events is higher and BNP adds significantly to the predictive value of SCORE as determined by likelihood ratios. The net reclassification improvement for BNP compared to stage B heart failure was 0.20.
Conclusion:
This study demonstrates that in patients with hypertension, BNP is superior to ventricular dysfunction on echocardiography in the prediction of risk of MACE and death in a community-based cohort of patients with complicated and uncomplicated hypertension.