Piercarlo Ballo1, Irene Betti2, Alessandro Barchielli3, Daniela Balzi4, Gabriele Castelli5, Leonardo De Luca6, Mihai Gheorghiade7, Alfredo Zuppiroli8. 1. Department of Cardiology, S. Maria Annunziata Hospital, Via dell'antella 58, Florence, Italy. pcballo@tin.it. 2. Department of Cardiology, S. Maria Annunziata Hospital, Via dell'antella 58, Florence, Italy. 3. Institute for Oncological Studies and Prevention, Florence, Italy. 4. Epidemiology Unit, Local Health Authority, Florence, Italy. 5. Department of Cardiology, Careggi Hospital, Florence, Italy. 6. Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, Rome, Italy. 7. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 8. Regional Health Agency, Local Health Authority, Florence, Italy.
Abstract
BACKGROUND: The association between natriuretic peptides and clinical outcome in asymptomatic hypertensive and diabetic patients with no clinical evidence of heart failure (HF) is still unclear. We assessed the prognostic value of NT-pro BNP, and its interactions with age and gender, in a cohort of asymptomatic, stage A/B HF hypertensive and diabetic patients enrolled in primary care. METHODS: NT-proBNP was measured in 1012 asymptomatic subjects with systemic hypertension and/or type-2 diabetes (age 66.6 ± 7.8 years, 48 % males) with no clinical evidence of HF. Patients were prospectively followed over 49.8 ± 6.7 months for the development of cardiac death, HF hospitalization, and nonfatal myocardial infarction. RESULTS: Patients with NT-proBNP above the 80th age- and gender-specific percentile showed a threefold risk of events as compared to those with NT-proBNP under this cut-off [hazard ratio 3.2 (2.6-8.3), p < 0.0001]. In multivariable analysis, NT-proBNP added independent and incremental prognostic information to a predictive model including established risk factors (p < 0.0001). After stratification by age, increased NT-proBNP predicted outcome among patients in the second and third age tertiles, but not among those in the first tertile. Increased NT-proBNP was associated with a 3.6-fold risk in women and a 2.9-fold risk in men. Addition of the gender-NT-proBNP interaction to prognostic models further improved prediction of events (p = 0.014). CONCLUSIONS: NT-proBNP measurement adds independent and incremental information for the prediction of clinical outcome in asymptomatic, stage A-B HF hypertensive and diabetic patients taken from primary care. This prognostic value might be further evident in the elderly and among women.
BACKGROUND: The association between natriuretic peptides and clinical outcome in asymptomatic hypertensive and diabeticpatients with no clinical evidence of heart failure (HF) is still unclear. We assessed the prognostic value of NT-pro BNP, and its interactions with age and gender, in a cohort of asymptomatic, stage A/B HF hypertensive and diabeticpatients enrolled in primary care. METHODS: NT-proBNP was measured in 1012 asymptomatic subjects with systemic hypertension and/or type-2 diabetes (age 66.6 ± 7.8 years, 48 % males) with no clinical evidence of HF. Patients were prospectively followed over 49.8 ± 6.7 months for the development of cardiac death, HF hospitalization, and nonfatal myocardial infarction. RESULTS:Patients with NT-proBNP above the 80th age- and gender-specific percentile showed a threefold risk of events as compared to those with NT-proBNP under this cut-off [hazard ratio 3.2 (2.6-8.3), p < 0.0001]. In multivariable analysis, NT-proBNP added independent and incremental prognostic information to a predictive model including established risk factors (p < 0.0001). After stratification by age, increased NT-proBNP predicted outcome among patients in the second and third age tertiles, but not among those in the first tertile. Increased NT-proBNP was associated with a 3.6-fold risk in women and a 2.9-fold risk in men. Addition of the gender-NT-proBNP interaction to prognostic models further improved prediction of events (p = 0.014). CONCLUSIONS: NT-proBNP measurement adds independent and incremental information for the prediction of clinical outcome in asymptomatic, stage A-B HF hypertensive and diabeticpatients taken from primary care. This prognostic value might be further evident in the elderly and among women.
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