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A Clinical Prediction Model for Selective NT-proBNP Testing in Hypertension
Anping Cai1,2, Lin Liu3, Xiangbing Yu2
1Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Journal of Clinical Hypertension (Greenwich, Conn.)
|June 19, 2026
Summary
A new point-based score effectively identifies individuals with hypertension experiencing heart stress, a pre-heart failure state. This practical tool guides selective NT-proBNP testing, improving efficiency in pre-heart failure screening.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is recommended for pre-heart failure (pre-HF) screening.
- Universal NT-proBNP testing is often infeasible and inefficient due to cost and resource limitations.
Purpose of the Study:
- To develop and validate a practical clinical model to identify individuals with hypertension at risk for heart stress, a pre-HF state.
- To guide selective NT-proBNP testing strategies for improved efficiency in pre-HF screening.
Main Methods:
- Analysis of data from 4642 U.S. adults with hypertension (NHANES 1999-2004).
- Definition of heart stress using age-specific NT-proBNP cutoffs.
- Multivariable logistic regression to identify associated factors and construct a point-based score, internally validated using bootstrapping.
Main Results:
- Heart stress was prevalent in 31% of hypertensive individuals.
- Key associated factors included older age, smoking, prior coronary heart disease, elevated systolic blood pressure, lower diastolic blood pressure, and reduced estimated glomerular filtration rate.
- The derived score demonstrated acceptable discrimination (AUC 0.71) and good calibration, with an optimal cutoff of 6 points.
Conclusions:
- A simple, point-based clinical score can effectively identify hypertensive individuals with prevalent heart stress.
- This model offers a practical approach to optimize selective NT-proBNP testing for pre-HF screening.
- Individuals identified with higher predicted heart stress probability showed significantly increased all-cause and cardiovascular mortality risk.
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