Abstract-Natriuretic peptides are controregulatory hormones associated with cardiac remodeling, namely, left ventricular hypertrophy and systolic/diastolic dysfunction. We intended to address the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in hypertension. We prospectively studied the relationship between plasma NTproBNP and all-cause mortality in 684 hypertensive patients with no history or symptoms of heart failure referred for hypertension workup in our institution from 1998 to 2008. After a mean duration of 5.7 years, we observed 40 deaths (1.04 deaths per 100 patients per year). After adjustment for traditional cardiovascular risk factors, including ambulatory blood pressure and serum creatinine, the risk for all-cause mortality more than doubled with each increment of 1 log NT-proBNP (hazard ratio: 2.33 [95% CI: 1.36 to 3.96]). The risk of death of patients with plasma NT-proBNP Ն133 pg/mL (third tertile of the distribution) was 3.3 times that of patients with values Ͻ50.8 pg/mL (first tertile; hazard ratio: 3.30 [95% CI: 0.90 to 12.29]). This predictive value was independent of, and superior to, that of 2 ECG indexes of left ventricular hypertrophy, the Sokolov-Lyon index and the amplitude of the R wave in lead aVL. In addition, it persisted in patients without ECG left ventricular hypertrophy, which allowed refining risk stratification in this relatively low-risk patient category. In this large sample of hypertensive patients, plasma NT-proBNP appeared as a strong prognostic marker. This performance, together with the ease of measurement, low cost, and widespread availability of NT-proBNP test kits, should prompt a wide use of this marker for risk stratification in hypertension. (Hypertension. 2011;57:702-709.)Key Words: hypertension Ⅲ NT-proBNP Ⅲ survival Ⅲ risk stratification Ⅲ left ventricular hypertrophy I n hypertension, detection of cardiac damages is critical for risk stratification. 1 This is usually done by searching for left ventricular hypertrophy (LVH), a major predictor of cardiovascular events. 2,3 However, in clinical practice, LVH detection is subject to various limitations. ECG is recommended by most guidelines but has a poor sensitivity and is rarely performed in clinical practice. 4 Echocardiography is extensively used but is time consuming, expensive, and not always feasible for technical reasons. The cost-effectiveness of its systematic use in hypertensive patients is still widely debated. 5 Thus, there is still room for new cardiac markers to be used for risk stratification.In response to volume expansion and pressure load, ventricular myocytes release a cardiac hormone, the B-type natriuretic peptide (BNP), together with its amino-terminal fragment, the N-terminal proBNP (NT-proBNP). 6 BNP and NT-proBNP are strong prognostic markers in advanced stages of cardiac diseases like heart failure 7 or coronary disease. 8 They are also closely related to cardiac geometry and mass, 9 and we have recently demonstrated the good performance of plasma NTproBNP for t...
