Use of natriuretic peptides in diagnosis of left ventricular hypertrophy in obese hypertensive patients with metabolic syndrome

Czech version

Authors: J. Špác ¹; M. Beránek ²; H. Němcová ¹; Bohuslav Kianička ¹; M. Souček ¹
Authors‘ workplace: II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Miroslav Souček, CSc. ¹; Data Marketing Management s. r. o., Brno, ředitel RNDr. Michal Beránek ²
Published in: Vnitř Lék 2013; 59(9): 769-775
Category: Original Contributions

Overview

Introduction:
Presence of left ventricular (LV) hypertrophy significantly increases cardiovascular risk in patients suffering from hypertension. Diagnostics of LV hypertrophy in hypertensive patients is not easy and there is still no method of enabling a simple and sufficiently sensitive diagnosis across a large patient population. The golden standard in LV hypertrophy diagnostics is echocardiography, and there are adverse opinions regarding the use of natriuretic peptides BNP and NT‑ proBNP (NP) to diagnose LV hypertrophy.

Patients and methods:
We examined through echocardiography 173 hypertensive patients with signs of metabolic syndrome and a moderate increase in blood pressure (130– 159/ 85– 99 mm Hg) with an average age of 54.8 ± 13.54 years, i.e. 119 men and 54 women, who were divided into 2 groups; 1 with BMI > 30 (group A with a severe obesity) and the other without obesity, BMI < 30 (group B). Both groups were examined for BNP and NT‑ proBNP levels.

Results:
We found a positive correlation between NP and LVMi, both for BNP (r = 0.169; p = 0.033) and for NT‑ proBNP (r = 0.240; p = 0.002). NT‑ proBNP statistically significantly predicts the given LV hypertrophy LK in people with BMI < 30 but not in obese people (BMI > 30).

Conclusion:
Obese patients suffer from a higher occurrence of left ventricular hypertrophy and paradoxically a lower NP value than patients with a metabolic syndrome (MS) who are not obese. Natriuretic peptides have a limited diagnostic value when assessing left ventricular hypertrophy. They are only of value in patients who are not obese and whose kidney function and systolic myocardial function have not been impaired.

Key words:
left ventricular hypertrophy – metabolic syndrome

Sources

1. Nishikimi T, Yoshihara F, Morimoto A et al. Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension. Hypertension 1996; 28: 22– 30.

2. Jakubík P, Janota T, Wichterle D et al. Může závažná esenciální hypertenze způsobit vzestup BNP vedoucí k falešné diagnóze srdečního selhání? Cor Vasa 2006; 48: 48– 54.

3. Gardner DG, Chen S, Glenn DJ et al. Molecular Biology of Natriuretic Peptide System. Hypertension 2007; 49: 419– 426.

4. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143– 3421.

5. Sahn DJ, DeMaria A, Kisslo J et al. The committee on Mode Standardization of the American Society of Echocardiography: recommendations regarding quantification in Mode echocardiography: results of a survey of echocardiographic methods. Circulation 1978; 58: 1072– 1083.

6. de Simone G, Daniels SR, Devereux RB et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251– 1260.

7. Hildebrandt P, Boesen M, Olsen M et al. N‑terminal pro brain natriuretic peptide in arterial hypertension – a marker for left ventricular dimensions and prognosis. Eur J Heart Fail 2004; 6: 313– 317.

8. Muller‑ Brunotte R, Kahana T, Lopez B et al. Myocardial fibrosis and diastolic dysfunction in patients with hypertension: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVIA). J Hypertens 2007; 25: 1958– 1966.

9. Almeida P, Azevedo A, Rodrigues R et al. B type natriuretic peptide and left ventricular hypertrophy in hypertensive patients. Rev Port Variol 2003; 22: 327– 336.

10. Gomes AH, Morillas P, Quiles J et al. Diagnostic accuracy of NT pro BNP compared with the electrocardiogram in detecting left ventricular hypertrophy of hypertensive origin. ESC Congress, Paris 2011.

11. Lopez B, González A, Lasarte JJ et al. Is plasma cardiotrophin‑1 a marker of hypertensive heart disease? J Hypertens 2005; 23: 625– 632.

12. Olsen MH, Hansen TW, Christensen MK et al. N‑terminal pro brain natriuretic peptide is inversely related to metabolic cardiovascular risk factors and the metabolic syndrome. Hypertension 2005; 46: 660– 666.

13. Kälsch H, Neumann T, Erbel R. Less increase of BNP and NT pro BNP levels in obese patient with decompensated heart failure: interpretation of natriuretic peptides in obesity. Int J Cardiol 2009; 133: e22– e24.

14. Krauser DG, Lloyd‑ Jones DM, Chae CU et al. Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure. A ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) substudy. Am Heart J 2005; 149: 744– 750.

15. Davis ME, Richards AM, Nicholls MG et al. Introduction of metoprolol increases plasma B‑type cardiac natriuretic peptides in mild, stable heart failure. Circulation 2006; 113: 977– 985.

16. de Simone G, Muiesan ML, Ganau A et al. Reliability and limitations of echocardiographic measurement of left mass for risk stratification and follow‑up in single patients. The RES trial. Working group on Heart and Hypertension of the Italian Society of Hypertension. Reliability of M‑ mode Echocardiographic Studies. J Hypertens 1999; 17: 1955– 1963.

17. de Simone G, Daniels SR, Devereux RB et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251– 1260.

18. Frohlich ED, Gonzalez A, Díez J. Hypertensive left ventricular hypertrophy risk: beyond adaptive cardiomyocytic hypertrophy. J Hypertens 2011; 29: 17– 26.