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)

B. C. Astor, S. Yi, L. Hiremath, T. Corbin, V. Pogue, B. Wilkening, G. Peterson, J. Lewis, J. P. Lash, F. Van Lente, J. Gassman, X. Wang, G. Bakris, L. J. Appel, G. Contreras

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

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 • 1.73 m 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 (Pinteraction=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.

Original languageEnglish (US)
Pages (from-to)1685-1692
Number of pages8
JournalCirculation
Volume117
Issue number13
DOIs
StatePublished - Apr 1 2008

Keywords

  • Cardiovascular diseases
  • Heart failure
  • Hypertension, renal
  • Kidney
  • Natriuretic peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Astor, B. C., Yi, S., Hiremath, L., Corbin, T., Pogue, V., Wilkening, B., Peterson, G., Lewis, J., Lash, J. P., Van Lente, F., Gassman, J., Wang, X., Bakris, G., Appel, L. J., & Contreras, G. (2008). 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). Circulation, 117(13), 1685-1692. https://doi.org/10.1161/CIRCULATIONAHA.107.724187