Abstract
We examined the relationship between plasma B-type natriuretic peptide (BNP) level and diurnal variability pattern of blood pressure (BP). Twenty-four-hour ambulatory BP monitoring was performed in 98 patients with asymptomatic essential hypertension, and the patients were classified into four groups according to their circadian BP variation profiles: dippers (n=29), nondippers (n=36), extreme dippers (n=19), and risers (n=14). Plasma BNP was measured by enzyme immunoassay. Based on the distribution pattern of BNP values, the values were analyzed after logarithmic transformation. Significant differences in plasma BNP levels among the types of circadian BP variations were demonstrated by analysis of variance (p<0.0005). Nondippers and risers showed significantly higher plasma BNP levels (mean [range: −1 SD and +1 SD]: 16.1 [6.3, 41.6] pg/mL and 29.2 [15.9, 53.4] pg/mL, respectively) than dippers (8.4 [3.7, 19.1] pg/mL). The area under the receiver operating characteristics curve for distinguishing patients with abnormal circadian BP variation from those with normal variation was 0.72, indicating that plasma BNP levels were useful for distinguishing between these patients. Specificity of 69% and sensitivity of 72% were obtained with a cut-off value of 10.5 pg/mL (log plasma BNP, 1.02) for distinguishing the abnormal diurnal BP profile group from the normal group. In conclusion, hypertensive patients with abnormal diurnal BP variation patterns (nondippers, extreme dippers, and risers) showed higher plasma BNP levels than those with normal circadian BP variation (dippers). Plasma BNP level is clinically useful for the identification of hypertensive patients who have abnormal circadian BP variability, which increases the risk of cardiovascular events.
Similar content being viewed by others
Article PDF
References
Hirotsu C, Ohta E, Hirose N, Shimizu K : Profile analysis of 24-hours measurements of blood pressure. Biometrics 2003; 59: 907–915.
Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K : Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001; 38: 852–857.
O'Brien E, Sheridan J, O'Malley K : Dippers and non-dippers. Lancet 1988; 2: 397.
Ohkubo T, Imai Y, Tsuji I, et al: Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study. Am J Hypertens 1997; 10: 1201–1207.
Shimada K, Kawamoto A, Matsubayashi K, Nishinaga M, Kimura S, Ozawa T : Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension. J Hypertens 1992; 10: 875–878.
Verdecchia P, Schillaci G, Borgioni C, et al: Altered circadian blood pressure profile and prognosis. Blood Press Monit 1997; 2: 347–352.
Kario K, Matsuo T, Kobayashi H, Imiya M, Matsuo M, Shimada K : Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension 1996; 27: 130–135.
Imai Y : Prognostic significance of ambulatory blood pressure. Blood Press Monit 1999; 4: 249–256.
Yasue H, Yoshimura M, Sumida H, et al: Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994; 90: 195–203.
Ogawa Y, Nakao K, Mukoyama M, et al: Rat brain natriuretic peptide—tissue distribution and molecular form. Endocrinology 1990; 126: 2225–2227.
Ogawa Y, Nakao K, Mukoyama M, et al: Natriuretic peptides as cardiac hormones in normotensive and spontaneously hypertensive rats. The ventricle is a major site of synthesis and secretion of brain natriuretic peptide. Circ Res 1991; 69: 491–500.
Hosoda K, Nakao K, Mukoyama M, et al: Expression of brain natriuretic peptide gene in human heart. Production in the ventricle. Hypertension 1991; 17: 1152–1155.
Mukoyama M, Nakao K, Hosoda K, et al: Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 1991; 87: 1402–1412.
Omland T, Aakvaag A, Vik-Mo H : Plasma cardiac natriuretic peptide determination as a screening test for the detection of patients with mild left ventricular impairment. Heart 1996; 76: 232–237.
Rodeheffer RJ : Measuring plasma B-type natriuretic peptide in heart failure: good to go in 2004? J Am Coll Cardiol 2004; 44: 740–749.
Tsutamoto T, Wada A, Maeda K, et al: Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation 1997; 96: 509–516.
Suzuki M, Hamada M, Yamamoto K, Kazatani Y, Hiwada K : Brain natriuretic peptide as a risk marker for incident hypertensive cardiovascular events. Hypertens Res 2002; 25: 669–676.
Mueller T, Gegenhuber A, Dieplinger B, Poelz W, Haltmayer M : Capability of B-type natriuretic peptide (BNP) and amino-terminal proBNP as indicators of cardiac structural disease in asymptomatic patients with systemic arterial hypertension. Clin Chem 2005; 51: 2245–2251.
Conen D, Zeller A, Pfisterer M, Martina B : Usefulness of B-type natriuretic peptide and C-reactive protein in predicting the presence or absence of left ventricular hypertrophy in patients with systemic hypertension. Am J Cardiol 2006; 97: 249–252.
Wofford MR, King DS, Wyatt SB, Jones DW : Secondary hypertension: detection and management for the primary care provider. J Clin Hypertens (Greenwich) 2000; 2: 124–131.
Rossi GP, Seccia TM, Pessina AC : Clinical use of laboratory tests for the identification of secondary forms of arterial hypertension. Crit Rev Clin Lab Sci 2007; 44: 1–85.
World Medical Association Declaration of Helsinki : ethical principles for medical research involving human subjects. JAMA 2000; 284: 3043–3045.
Kono M, Yamauchi A, Tsuji T : An immunoradiometric assay for brain natriuretic peptide in human plasam. Jpn Soc Nucl Med Technol 1993; 13: 2–7.
Ono H, Morita J, Morita K : Evaluation of BNP and troponin T measuring reagents using the full-auto micro plate chemiluminescence analyzer AP-96c. J Anal Bio-Sci 2004; 27: 335–342 ( in Japanese).
Knudsen CW, Omland T, Clopton P, et al: Impact of atrial fibrillation on the diagnostic performance of B-type natriuretic peptide concentration in dyspneic patients: an analysis from the breathing not properly multinational study. J Am Coll Cardiol 2005; 46: 838–844.
Clerico A, Emdin M : Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides: a review. Clin Chem 2004; 50: 33–50.
Furst H, Hartl WH, Haberl R, et al: Silent cerebral infarction: risk factor for stroke complicating carotid endarterectomy. World J Surg 2001; 25: 969–974.
Ezekowitz MD, James KE, Nazarian SM, et al, The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators: Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. Circulation 1995; 92: 2178–2182.
Mallion JM, Baguet JP, Siche JP, Tremel F, De Gaudemaris R : Clinical value of ambulatory blood pressure monitoring. J Hypertens 1999; 17: 585–595.
Timio M, Venanzi S, Lolli S, et al: “Non-dipper” hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study. Clin Nephrol 1995; 43: 382–387.
Maisel A : B-type natriuretic peptide measurements in diagnosing congestive heart failure in the dyspneic emergency department patient. Rev Cardiovasc Med 2002; 3 ( Suppl 4): S10–S17.
McCullough PA, Nowak RM, McCord J, et al: B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 2002; 106: 416–422.
Clerico A, Del Ry S, Maffei S, Prontera C, Emdin M, Giannessi D : The circulating levels of cardiac natriuretic hormones in healthy adults: effects of age and sex. Clin Chem Lab Med 2002; 40: 371–377.
Sherwood A, Steffen PR, Blumenthal JA, Kuhn C, Hinderliter AL : Nighttime blood pressure dipping: the role of the sympathetic nervous system. Am J Hypertens 2002; 15: 111–118.
Arita M, Minami E, Nakamura C, Ueno Y, Nishio I, Masuyama Y : Role of the sympathetic nervous system in the nocturnal fall in blood pressure. Hypertens Res 1996; 19: 195–200.
Takakuwa H, Ise T, Kato T, et al: Diurnal variation of hemodynamic indices in non-dipper hypertensive patients. Hypertens Res 2001; 24: 195–201.
Rizzoni D, Muiesan ML, Montani G, Zulli R, Calebich S, Agabiti-Rosei E : Relationship between initial cardiovascular structural changes and daytime and nighttime blood pressure monitoring. Am J Hypertens 1992; 5: 180–186.
Verdecchia P, Schillaci G, Guerrieri M, et al: Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528–536.
Feola M, Boffano GM, Procopio M, Reynaud S, Allemano P, Rizzi G : Ambulatory 24-hour blood pressure monitoring: correlation between blood pressure variability and left ventricular hypertrophy in untreated hypertensive patients. G Ital Cardiol 1998; 28: 38–44.
Cuspidi C, Michev I, Meani S, et al: Reduced nocturnal fall in blood pressure, assessed by two ambulatory blood pressure monitorings and cardiac alterations in early phases of untreated essential hypertension. J Hum Hypertens 2003; 17: 245–251.
Della Mea P, Lupia M, Bandolin V, et al: Adiponectin, insulin resistance, and left ventricular structure in dipper and nondipper essential hypertensive patients. Am J Hypertens 2005; 18: 30–35.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nakatsu, T., Shinohata, R., Mashima, K. et al. Use of Plasma B-Type Natriuretic Peptide Level to Identify Asymptomatic Hypertensive Patients with Abnormal Diurnal Blood Pressure Variation Profiles: Nondippers, Extreme Dippers, and Risers. Hypertens Res 30, 651–658 (2007). https://doi.org/10.1291/hypres.30.651
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.30.651
Keywords
This article is cited by
-
Cross-sectional study of indices of dynamic components of ambulatory blood pressure and cardiac damage in elderly male patients with essential hypertension
Aging Clinical and Experimental Research (2014)