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)

被引：37

作者：

Astor, B. C. ^{[1
,2
]}

Yi, S. ^{[1
]}

Hiremath, L. ^{[3
]}

Corbin, T. ^{[4
]}

Pogue, V. ^{[5
]}

Wilkening, B. ^{[6
]}

Peterson, G. ^{[7
]}

Lewis, J. ^{[8
]}

Lash, J. P. ^{[9
]}

Van Lente, F. ^{[10
,11
]}

Gassman, J. ^{[12
]}

Wang, X. ^{[12
]}

Bakris, G. ^{[13
]}

Appel, L. J. ^{[1
,2
]}

Contreras, G. ^{[14
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Dept Epidemiol, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA

[2] Johns Hopkins Univ, Sch Med, Dept Med, Div Gen Internal Med, Baltimore, MD 21205 USA

[3] Ohio State Univ, Dept Nephrol, Columbus, OH 43210 USA

[4] Univ Michigan, Dept Med, Div Internal Med, Ann Arbor, MI 48109 USA

[5] Columbia Univ Coll Phys & Surg, Harlem Hosp Ctr, Dept Med, New York, NY 10032 USA

[6] Emory Univ, Dept Med, Div Renal, Atlanta, GA 30322 USA

[7] Univ Texas SW Med Ctr Dallas, Dept Internal Med, Dallas, TX 75390 USA

[8] Vanderbilt Univ, Div Nephrol, Nashville, TN USA

[9] Univ Illinois, Nephrol Sect, Chicago, IL USA

[10] Cleveland Clin Fdn, Dept Clin Pathol, Cleveland, OH 44195 USA

[11] Cleveland Clin Fdn, Dept Hypertens & Nephrol, Cleveland, OH 44195 USA

[12] Cleveland Clin Fdn, Dept Quantitat Hlth Sci, Cleveland, OH 44195 USA

[13] Univ Chicago, Pritzker Sch Med, Dept Med, Chicago, IL 60637 USA

[14] Univ Miami, Miller Sch Med, Dept Med, Div Nephrol & Hypertens, Miami, FL 33152 USA

来源：

CIRCULATION | 2008年 / 117卷 / 13期

关键词：

cardiovascular diseases; heart failure; hypertension; renal; kidney; natriuretic peptides;

D O I：

10.1161/CIRCULATIONAHA.107.724187

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1685 / 1692

页数：8

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