ASSOCIATION BETWEEN BRAIN NATRIURETIC PEPTIDE LEVELS AND MARKERS OF THE SEVERITY OF RESISTANT ARTERIAL HYPERTENSION

Highlights

The complex role of the brain natriuretic peptide in the pathogenesis of arterial hypertension, as well as the successful use of the N-terminal fragment of the prohormone brain-type natriuretic peptide as a biomarker of cardiovascular diseases determine the relevance of this work.

Aim. To study the association between brain natriuretic peptide levels (NT-proBNP) and markers of the severity of resistant arterial hypertension.

Methods. The study included 40 patients with diagnosed resistant arterial hypertension (RAH) and 30 patients with AH. All patients underwent clinical examination and measurement of NT-proBNP levels before and after receiving standard antihypertensive therapy.

Results. Before receiving standardized antihypertensive therapy (AHT), NT-proBNP levels in the group of patients with RAH and in the group of patients with non-resistant hypertension did not differ significantly (p = 0.48), but systolic BP was statistically significantly higher (p = 0.039) in the group of patients with RAH. RAH revealed a direct association between NT-proBNP and sodium (r = 0,38; p = 0.01), as well as a direct association between NT-proBNP and body mass index (r = 0,32; p = 0.02). Factor analysis revealed a relationship between NT-proBNP and age (p < 0.01), as well as a direct relationship between NT-proBNP and potassium (r = 0,29; p = 0.04). After receiving standardized AHT, NT-proBNP levels decreased in the RAH group and in the non-resistant AH group (p = 0.03; p = 0.0001), but the decrease was less pronounced in the RAH group. NT-proBNP levels after standardized AHT in the RAH group were higher (p < 0.0001) compared to the non-resistant AH group, and relatively high NT-proBNP levels were directly associated with the presence of RAH (p = 0.0025).

Conclusion. The results of the study indicate the presence of an association between NT-proBNP levels and resistant arterial hypertension. Supposedly, this association determines the uncontrolled course of resistant arterial hypertension – desensitization of receptors that regulate vascular tone, lipid metabolism disorders and natriuresis dysfunction.

1. Kobalava Z.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I. et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. doi.10.15829/1560-4071-2020-3-3786 (In Russian)

2. Jordan J., Birkenfeld A.L., Melander O., Moro C. Natriuretic Peptides in Cardiovascular and Metabolic Crosstalk: Implications for Hypertension Management. Hypertension. 2018;72(2):270-276. doi: 10.1161/HYPERTENSIONAHA.118.11081

3. Turkoglu E.I., Kircicegi Cıcekdag E.C. Resistant hypertension in elderly: a clinical manifestation of heart failure with preserved ejection fraction? retrospective single-center analysis. Clin Exp Hypertens. 2019;41(6):505-510.doi: 10.1080/10641963.2018.1510945.

4. Kovаlevа A.Yа., Lukinov V.L., Lifshits G.I. Cognitive impairment in patients with atrial fibrillation and arterial hypertension. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2022;26(1):66-72. doi:10.21688/1681-3472-2022-1-66-72 (In Russian)

5. Türkoglu E.I., Şekercioglu E. Is There a Correlation Between Left Atrium Diameter and NT-ProBNP Levels in Resistant Hypertension? EJCM 2019;7(2):66-71 doi: 10.32596/ejcm.galenos.2019.00009

6. Podzolkov V.I., Bragina A.E., Osadchiy K.K. Resistant Hypertension: Questions and Contemporary Answers. Rational Pharmacotherapy in Cardiology 2019;15(4):568-577. doi:10.20996/1819-6446-2019-15-4-568-577 (In Russian)

7. Aksenova A.V., Sivakova O.A., Blinova N.V., Danilov N.M., Elfimova E.M., Kisliak O.A., Litvin A.Y., Oshchepkova E.V., Fomin V.V., Chikhladze N.M., Shelkova G.V., Chazova I.E. Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management. Terapevticheskii Arkhiv (Ter. Arkh). 2021; 93 (9): 1018–1029. doi: 10.26442/00403660.2021.09.201007 (In Russian)

8. Kovаlevа А.Y., Kokh N.V., Voroninа E.N., E., Donirova O., Zelenskаyа E., Slepukhina A., Lifshits G. Identification of ethnogenetic differences in genetic markers in the clinical course and damage to target organs in arterial hypertension in Russians and Buryats. Circulation Pathology and Cardiac Surgery. 2020;24(4):103-113. doi:10.21688/1681-3472-2020-4-103-113. (In Russian)

9. Fouassier D., Blanchard A., Fayol A., Bobrie G., Boutouyrie P., Azizi M., Hulot J.S. Sequential nephron blockade with combined diuretics improves diastolic function in patients with resistant hypertension. ESC Heart Fail. 2020 Oct;7(5):2561-2571. doi: 10.1002/ehf2.12832.

10. Wang B., Wang G.H., Ding X.X., Tang H.X., Zheng J., Liu B.C., Zhang X.L. Effects of Sacubitril/Valsartan on resistant hypertension and myocardial work in hemodialysis patients. J Clin Hypertens (Greenwich). 2022;24(3):300-308. doi: 10.1111/jch.14422

11. Bovee D.M., Visser W.J., Middel I., De Mik-van Egmond A., Greupink R., Masereeuw R., Russel F.G.M., Danser A.H.J., Zietse R., Hoorn E.J. A Randomized Trial of Distal Diuretics versus Dietary Sodium Restriction for Hypertension in Chronic Kidney Disease. J Am Soc Nephrol. 2020;31(3):650-662. doi: 10.1681/ASN.2019090905.

12. Kovalenko E.V., Markova L.I., Belaya O.L. Mineralocorticoid-receptor antagonists in the management chronic heart failure: the effectiveness and promising opportunities. International Heart and Vascular Disease Journal. 2022. 10 (34): 33–43. doi: 10.24412/2311-1623-2022-34-33-43. (In Russian)

13. Kovaleva A.Ya., Kokh N.V., Voronina E.N., Donirova O. S., Zelenskaya E.M., Lifshits G.I. The relationship of genetic risk factors with the development of arterial hypertension taking into account ethnic differences. Russian Journal of Cardiology. 2019;24(10):66–71. doi:10.15829/1560-4071-2019-10-66-71 (In Russian)