Serum Brain Natriuretic Peptide Levels Correlate with the Severity of Hypertension in a Population of Nigerian Patients.

Main Article Content

Chiebonam E Nwajiobi
Bruno Basil
Ugochukwu J Okoli

Keywords

Brain Natriuretic Peptide (BNP), Correlate, Nigeria, Hypertension Severity

Abstract

Background: Hypertension is a major global health concern requiring precise risk assessment. Brain Natriuretic Peptide (BNP) has emerged as a potential biomarker, but its relationship with hypertension severity requires exploration to evaluate its potential as a risk prediction tool. This study aimed to assess the relationship between serum BNP levels and the severity of hypertension in a population of Nigerian patients.


Methodology: This was an analytical cross-sectional case-controlled study involving 103 hypertensive patients and 98 controls. Participants were grouped based on World Health Organization (WHO) criteria for diagnosis of Hypertension and the severity of hypertension was categorized based on blood pressure readings. The mean BNP levels were assessed among different hypertension grades, while logistic regression was used to assess the odds of higher severity with elevated BNP.


Results: Serum BNP levels were significantly higher in hypertensive individuals (616.5 ± 66.3 pg/mL) compared to controls (501.1 ± 84.6 pg/mL) and varied significantly across different hypertension grades (p = 0.000). A positive correlation was observed between serum BNP and hypertension severity (r = 0.736, p < 0.001). Logistic regression analysis indicated increasing odds of higher severity with elevated BNP from Grade 1 to Grade 3 hypertension.


Conclusion: This study established a positive correlation between serum BNP levels and hypertension severity, indicating its potential as a predictive biomarker for risk stratification in hypertensive individuals.

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References

1. Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: Hypertension at the core. Cannadian Journal of Cardiology. 2015; (5): 569-571.

2. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B.
editors. World Health Organization, Geneva 2011.

3. Pokharel Y, Karmacharya BM, Neupane D. Hypertension – A Silent Killer Without Global Bounds: What Next? Journal of the American College of Cardiology. 2022; 80(8): 818-820.

4. Fuchs FD, Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension. 2020; 75(2): 285-292.

5. Kjeldsen SE. Hypertension and cardiovascular risk: General aspects. Pharmacological Research. 2018; 129: 95-99.

6. Schutte AE, Kollias A, Stergiou GS. Blood pressure and its variability: classic and novel measurement techniques. Nature Reviews Cardiology. 2022; 19: 643-654.

7. Flack JM, Adekola B. Trends in Cardiovascular Medicine Blood pressure and the new ACC / AHA hypertension guidelines. Trends Cardiovasc Med. 2020; 30(3): 160-164.

8. World Health Organization. Hypertension. Available at: https://www.who.int/healthtopics/hypertension#tab=tab_1[Accessed Sept 2023]

9. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360 (9349):1903-1913.

10. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005; 3652(9455):2217-223.

11. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: A systematic review. Journal of Hypertension. 2004; 22(1):11-9.

12. Adebayo RA, Balogun MO, Adedoyin RA, Obashoro-John OA, Bisiriyu LA, Abiodun OO. Prevalence of hypertension in three rural communities of Ife North Local Government Area of Osun State, South West Nigeria. Int J Gen Med. 2013; 6: 863-868.

13. Olatunbosun ST, Kaufman JS, Cooper RS, Bella AF. Hypertension in a Black population: Prevalence and biosocial determinants of high blood pressure in a group of urban Nigerians. J Hum Hypertens. 2000; 14(4): 249-257.

14. Adeloye D, Basquill C, Aderemi A V., Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens. 2015; 33(2):230-242.

15. Ogah OS. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol. 2012; 4(12): 327-340.

16. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: A systematic review. Journal of Hypertension. 2017; 35(3): 421–441.

17. Takeda T, Kohno M. Brain Natriuretic Peptide in Hypertension. Hypertens Res - Clin Exp. 1995; 18(4): 259-266.
18. de Bold AJ, Borenstein HB, Veress AT, Sonnenberg H. A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats. Reprinted from Life Sci. 28:89-94, 1981. J Am Soc Nephrol. 2001; 28(1):89-94.

19. Kangawa K, Fukuda A, Kubota I, Hayashi Y, Minamitake Y, Matsuo H. Human atrial natriuretic polypeptides (hANP): Purification, structure synthesis and biological activity. J Hypertens. 1984; ;2(3): S321-323.

20. Schweitz H, Vigne P, Moinier D, Frelin C, Lazdunski M. A new member of the natriuretic peptide family is present in the venom of the Green Mamba (Dendroaspis angusticeps). J Biol Chem. 1992; 267(20):13928-13932.

21. Clerico A, Iervasi G, Mariani G. Pathophysiologic relevance of measuring the plasma levels of cardiac natriuretic peptide hormones in humans. Hormone and Metabolic Research. 1999; 31(9):487-498.

22. Furumoto T, Fujii S, Tsutsui H. Abstract 2466: Increased Plasma Concentrations of N-Terminal Pro Brain Natriuretic Peptide is a More Sensitive Marker of Subclinical Diastolic Dysfunction and Arterial Remodeling in Hypertension: Analytical Performance Comparison with BNP. Circulation. 2008; 118: S18 (Abstract).

23. Goodyear MDE, Krleza-Jeric K, Lemmens T. The declaration of Helsinki. British Medical Journal. 2007; 335(7621): 624-625.

24. Daniel WW, Cross CL. Biostatistics: A Foundation for Analysis in the Health Sciences, 10th Edition. New York: John Wiley & Sons; 2013.

25. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension, The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023; 41(12):1874-2071.

26. Foulds HJA, Bredin SSD, Warburton DER. The relationship between hypertension and obesity across different ethnicities. J Hypertens. 2012; 30(2): 359-367.

27. Soleimani M. Insulin resistance and hypertension: New insights. Kidney International. 2015; 87(3): 497-499.

28. da Silva AA, do Carmo JM, Li X, Wang Z, Mouton AJ, Hall JE. Role of Hyperinsulinemia and Insulin Resistance in Hypertension: Metabolic Syndrome Revisited. Canadian Journal of Cardiology. 2020; 36(5): 671-682.

29. Russo B, Menduni M, Borboni P, Picconi F, Frontoni S. Autonomic nervous system in obesity and insulin-resistance— the complex interplay between leptin and central nervous system. Int J Mol Sci. 2021; 22(10): 5187.

30. Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Omland T, et al. Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death. N Engl J Med. 2004; 350(7): 655-663.

31. Panagopoulou V, Deftereos S, Kossyvakis C, Raisakis K, Giannopoulos G, Bouras G, et al. NTproBNP: An Important Biomarker in Cardiac Diseases. Curr Top Med Chem. 2013; 13(2): 82-94.

32. Wang AYM, Lam CWK, Yu CM, Wang M, Chan IHS, Zhang Y, et al. N-terminal pro-brain natriuretic peptide: An independent risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic peritoneal dialysis patients. J Am Soc Nephrol. 2007; 18(1): 321-330.

33. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature Reviews Cardiology. 2021; 18(11):785-802.

34. Rudolf H, Mügge A, Trampisch HJ, Scharnagl H, März W, Kara K. NT-proBNP for risk prediction of cardiovascular events and all-cause mortality: The get ABI-study. Int J Cardiol Heart Vasc. 2020; 29: 100553.

35. Hussain A, Sun W, Deswal A, de Lemos JA, McEvoy JW, Hoogeveen RC, et al. Association of NT-ProBNP, Blood Pressure, and Cardiovascular Events: The ARIC Study. J Am Coll Cardiol. 2021; 77(5): 559-571.

36. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, et al. Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure. N Engl J Med. 2002; 347(3): 161-167.