biostudies-literatureHussain ANIDDK NIH HHSNHLBI NIH HHSNational Institutes of HealthCSRD VA559-571https://www.ebi.ac.uk/biostudies/studies/S-EPMC7945981biostudies-literatureUnknown77(5)<h4>Background</h4>Although intensive blood pressure reduction has cardiovascular benefits, the absolute benefit is greater in those at higher cardiovascular disease (CVD) risk.<h4>Objectives</h4>This study examined whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) helps identify subjects at higher risk for CVD events across systolic blood pressure (SBP), diastolic blood pressure (DBP), or pulse pressure (PP) categories.<h4>Methods</h4>Participants from the ARIC (Atherosclerosis Risk In Communities) study visit 4 (1996 to 98) were grouped according to SBP, DBP, or PP categories and further stratified by NT-proBNP categories. Cox regression models were used to estimate hazard ratios for incident CVD (coronary heart disease, ischemic stroke, or heart failure hospitalization) and mortality across combined NT-proBNP and/or BP categories, adjusting for CVD risk factors.<h4>Results</h4>There were 9,309 participants (age: 62.6 ± 5.6 years; 58.3% women) with 2,416 CVD events over a median follow-up of 16.7 years. Within each SBP, DBP, or PP category, a higher category of NT-proBNP (100 to <300 or 300 pg/ml, compared with NT-proBNP <100 pg/ml) was associated with a graded increased risk for CVD events and mortality. Participants with SBP 130 to 139 mm Hg but NT-proBNP ≥300 pg/ml had a hazards ratio of 3.4 for CVD (95% confidence interval: 2.44 to 4.77) compared with a NT-proBNP of <100 pg/ml and SBP of 140 to 149 mm Hg.<h4>Conclusions</h4>Elevated NT-proBNP is independently associated with CVD and mortality across SBP, DBP, and PP categories and helps identify subjects at the highest risk. Participants with stage 1 hypertension but elevated NT-proBNP had greater cardiovascular risk compared with those with stage 2 SBP but lower NT-proBNP. Future studies are needed to evaluate use of biomarker-based strategies for CVD risk assessment to assist with initiation or intensification of BP treatment.Journal of the American College of CardiologyAssociation of NT-ProBNP, Blood Pressure, and Cardiovascular Events: The ARIC Study.PMC7945981K24 HL152440R01 HL150342R01 HL134320HHSN268201700003IHHSN268201700004IHHSN268201700005IR01 HL135008HHSN268201700001IHHSN268201700002IHHSN268201700005CR01 HL143224I01 CX001112R01 DK089174HHSN268201700001CHHSN268201700002CHHSN268201700003CHHSN268201700004CK24 DK106414K24 HL152008Hussain AVirani SSHoogeveen RCde Lemos JABallantyne CMBozkurt BNdumule CSun WDeswal AMatsushita KNambi VShah AMSelvin EAguilar DMcEvoy JWfalseAssociation of NT-ProBNP, Blood Pressure, and Cardiovascular Events: The ARIC Study.<h4>Background</h4>Although intensive blood pressure reduction has cardiovascular benefits, the absolute benefit is greater in those at higher cardiovascular disease (CVD) risk.<h4>Objectives</h4>This study examined whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) helps identify subjects at higher risk for CVD events across systolic blood pressure (SBP), diastolic blood pressure (DBP), or pulse pressure (PP) categories.<h4>Methods</h4>Participants from the ARIC (Atherosclerosis Risk In Communities) study visit 4 (1996 to 98) were grouped according to SBP, DBP, or PP categories and further stratified by NT-proBNP categories. Cox regression models were used to estimate hazard ratios for incident CVD (coronary heart disease, ischemic stroke, or heart failure hospitalization) and mortality across combined NT-proBNP and/or BP categories, adjusting for CVD risk factors.<h4>Results</h4>There were 9,309 participants (age: 62.6 ± 5.6 years; 58.3% women) with 2,416 CVD events over a median follow-up of 16.7 years. Within each SBP, DBP, or PP category, a higher category of NT-proBNP (100 to <300 or 300 pg/ml, compared with NT-proBNP <100 pg/ml) was associated with a graded increased risk for CVD events and mortality. Participants with SBP 130 to 139 mm Hg but NT-proBNP ≥300 pg/ml had a hazards ratio of 3.4 for CVD (95% confidence interval: 2.44 to 4.77) compared with a NT-proBNP of <100 pg/ml and SBP of 140 to 149 mm Hg.<h4>Conclusions</h4>Elevated NT-proBNP is independently associated with CVD and mortality across SBP, DBP, and PP categories and helps identify subjects at the highest risk. Participants with stage 1 hypertension but elevated NT-proBNP had greater cardiovascular risk compared with those with stage 2 SBP but lower NT-proBNP. Future studies are needed to evaluate use of biomarker-based strategies for CVD risk assessment to assist with initiation or intensification of BP treatment.2021-01-01T00:00:00Z2021 Feb2025-04-20T03:41:04.451Z2025-04-20T03:41:04.451ZS-EPMC79459813353825410.1016/j.jacc.2020.11.063