Relation of Plasma Midregional Proatrial Natriuretic Peptide to Target Organ Damage in Adults With Systemic Hypertension

• Published in: The American journal of cardiology Vol. 103; no. 9; pp. 1255 - 1260
• Main Authors: Khaleghi, Mahyar, MD, Al-Omari, Malik A., MD, Kondragunta, Venkateswarlu, PhD, Morgenthaler, Nils G., MD, Struck, Joachim, PhD, Bergmann, Andreas, PhD, Mosley, Thomas H., MD, Kullo, Iftikhar J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2009; Elsevier; Elsevier Limited
• Subjects: African Americans - statistics & numerical data; Age Distribution; Aged; Albuminuria - diagnosis; Albuminuria - epidemiology; Ankle Brachial Index; Arterial hypertension. Arterial hypotension; Atrial Natriuretic Factor - blood; Atrial Natriuretic Factor - metabolism; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood Pressure Determination; Cardiology; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Comorbidity; Comparative analysis; Creatinine - urine; European Continental Ancestry Group - statistics & numerical data; Female; Hispanic Americans - statistics & numerical data; Humans; Hypertension; Hypertension - blood; Hypertension - diagnosis; Hypertension - epidemiology; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - epidemiology; Hypothesis testing; Incidence; Male; Medical sciences; Middle Aged; Minority & ethnic groups; Peptides; Plasma; Predictive Value of Tests; Probability; Prognosis; Protein Precursors - blood; Protein Precursors - metabolism; Risk Assessment; Severity of Illness Index; Sex Distribution; Survival Analysis; Human; Hypertension; Peptides; Target organ; Cardiovascular disease; Adult; Systemic; Circulatory system; Disseminated; Cardiology; Blood plasma
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.01.012

We tested the hypothesis that, in adults with essential hypertension, plasma levels of midregional proatrial natriuretic peptide (MR-proANP) are associated with target organ damage. MR-proANP is a newly described stable fragment of N-terminal proatrial natriuretic peptide. Participants included 1,919 adults with hypertension identified from the community (1,037 African-Americans, 65 ± 9 years of age, 72% women; 882 non-Hispanic whites, 61 ± 9 years of age, 55% women). We measured MR-proANP by an immunoluminometric assay. Measurements of target organ damage included the ankle–brachial index (ABI), urinary albumin–creatinine ratio (UACR), and left ventricular (LV) mass (available only in African-Americans). Generalized estimating equations were used to assess whether plasma MR-proANP was associated with measurements of target organ damage, independent of potential confounding variables. In African-Americans, higher MR-proANP was significantly associated with lower ABI (p <0.0001), higher UACR (p <0.0001), and greater LV mass (indexed to height to the power of 2.7, p <0.0001). After adjustment for age, gender, body mass index, systolic blood pressure, estimated glomerular filtration rate, smoking history, diabetes mellitus, total and high-density lipoprotein cholesterols, medication (blood pressure lowering, statin, and aspirin) use, and previous myocardial infarction or stroke, higher MR-proANP levels remained significantly associated with lower ABI (p = 0.01), higher UACR (p = 0.0007), and greater LV mass index (p <0.0001). In non-Hispanic whites, higher MR-proANP levels were significantly associated with lower ABI (p = 0.002) and greater UACR (p = 0.001), but not after adjustment for the covariates listed earlier. In conclusion, plasma MR-proANP may be a marker of target organ damage in the setting of hypertension, especially in African-Americans.