NT-proBNP或有助评估降压疗效

临床医师

英国一项研究表明，N端脑利钠肽前体（NT-proBNP）可改善心血管疾病风险评估，并可帮助评估特定降压方案的疗效。该研究12月9日在线发表于《高血压》（Hypertension）杂志。

　　研究简介

　　研究者进行了三个假设：（1）NT-proBNP可预测高血压患者的心血管疾病事件；（2）NT-proBNP与血压变异性有关；（3）NT-proBNP预测可从抗高血压治疗中获益；

　　研究者从英属斯堪的那维亚心脏终点试验（Anglo-Scandinavian Cardiac Outcomes Trial，ASCOT）研究中随机抽取一个子集。共纳入6549例无冠心病病史的高危患者，随机给予基于阿替洛尔或氨氯地平的降压治疗。在5.5年随访期间，共出现485例心血管疾病，将485例患者与1367例对照者相匹配。在基线和试验6个月时测量NT-proBNP。

　　研究结果：

　　（1）NT-proBNP可在已确定预测因素基础上改善心血管疾病风险预测，净重分类改善为22.3%（P＜0.0001）。

　　（2）收缩压SD每升高1 mmHg，基线NT-proBNP水平升高2%（P＜0.0001）。

　　（3）然而，NT-proBNP预测心血管疾病风险独立于血压变异（OR 1.24，95% CI1.06-1.45，P=0.007）。

　　（4）6个月时，基于阿替洛尔的治疗使NT-proBNP升高69.6%（P＜0.0001）。相比之下，基于氨氯地平的治疗使NT-proBNP降低36.5%（P＜0.0001）。调整混杂因素后，与6个月时NT-proBNP不低于中位值（61 pg/mL）的氨氯地平组患者相比，NT-proBNP低于中位值者心血管疾病风险降低（OR 0.58，95% CI 0.37-0.91）。

　　结论：NT-proBNP可帮助改善心血管疾病风险评估，并帮助评估特定的降压方案疗效。进一步的相关研究非常必要。

　　原文阅读：The Value of N-Terminal Pro-B-Type Natriuretic Peptide in Determining Antihypertensive Benefit: Observations From the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).
　　Abstract
We investigated 3 hypotheses: (1) N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular disease events in patients with hypertension, (2) NT-proBNP is associated with blood pressure variability, and (3) NT-proBNP predicts benefit from antihypertensive regimens. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized a subset of 6549 patients at risk with no history of coronary heart disease to either atenolol-based or amlodipine-based blood pressure-lowering treatment. During 5.5 years of follow-up, 485 cardiovascular disease cases accrued and were matched with 1367 controls. Baseline and 6-month in-trial NT-proBNP were measured. The results show that NT-proBNP improves cardiovascular disease risk prediction beyond established predictors, continuous net reclassification improvement of 22.3% (P<0.0001). Furthermore, a 1-mm Hg increase in the SD of systolic blood pressure was associated with 2% higher baseline NT-proBNP in a multivariable regression analysis (P<0.0001). However, NT-proBNP predicted cardiovascular disease risk independently of blood pressure variation (odds ratio per SD increase in log NT-proBNP 1.24; 95% confidence interval, 1.06-1.45; P=0.007). Atenolol-based treatment led to a 69.6% increase in NT-proBNP at 6 months (P<0.0001). In contrast, amlodipine-based treatment reduced NT-proBNP by 36.5% (P<0.0001). Amlodipine recipients who achieved a 6-month NT-proBNP below the median (61 pg/mL) were at lower risk of cardiovascular disease when compared with those who did not (odds ratio, 0.58; 95% confidence interval, 0.37-0.91) after adjustment for confounders inclusive of baseline NT-proBNP and achieved blood pressure. If confirmed, these novel results suggest that NT-proBNP, as well as aiding cardiovascular disease risk assessment, may also help assess the efficacy of specific antihypertensive regimens. Further relevant studies seem warranted.