Usefulness of Serum Brain Natriuretic Peptide as a Predictor Biomarker of Renal Artery Stenosis in Patients with Resistant Hypertension

Year 2019, Volume: 3 Issue: 3, 155 - 163, 31.12.2019

Sevil Uygun İlikhan , Muammer Bilici

Abstract

Aim: In this study, we aimed to evaluate the relationship between BNP level and RAS in patients with resistant hypertension according to the results of renal arteriography.   

Material and Methods: Forty patients with resistant hypertension were included to the study. In order to compare to each other regarding the BNP levels, the patients were evaluated by dividing them into groups as RAS (group1; non-critical (1a) and critical (1b)), non-RAS (group 2), unilateral RAS (non-critical (A) and critical (B)) and bilateral RAS (non-critical (C) and critical (D)) according to the results of renal arteriography.  

Results: The serum BNP (p=0.003) and serum creatinine (p=0.015) levels of group 1b were also significantly higher than group 1a. The patients in group B had higher serum BNP levels (p=0.025) and lower creatinine clearance levels (p=0.041) compared to group A. Higher serum creatinine (p=0.006), serum BNP levels (p=0.017) and lower creatinine clearance levels (p=0.049) have been observed in group D compared to group C.  

Conclusion: Findings of this study revealed that increased serum BNP levels were significantly associated with the severity of RAS determined by the results of renal arteriography. Thus BNP may be used as a predictive marker to detect the presence of RAS in patients with resistant hypertension. 

Keywords

Brain natriuretic peptid, renal artery stenosis, resistant hypertension

Dirençli Hipertansiyonlu Hastalarda Serum Beyin Natriüretik Peptit Düzeylerinin Renal Arter Stenozunu Öngermede Bir Belirteç Olarak Kullanımı

Abstract

Amaç: Bu çalışmada dirençli hipertansiyon ön tanısıyla selektif renal arteriografisi yapılan ve renal arter stenozu (RAS) saptanan hastalarda serum beyin natriüretik peptit (BNP) düzeyleri ile RAS arasındaki ilişkiyi değerlendirmeyi amaçladık.  

Gereç ve Yöntemler: Dirençli hipertansiyonu olan 40  hasta bu çalışmaya alındı. Hastalar renal arter arteriografisi sonucuna göre RAS olan (Grup 1) ve olmayan (Grup 2) olmak üzere iki gruba ayrıldı. Renal arterde darlığı % 50’den az olanlar Grup 1a, diğerleri Grup 1b olarak kabul edildi. Unilateral non-kritik RAS tespit edilen hastalar Grup A, unilateral kritik RAS tespit edilenler Grup B, bilateral non-kritik RAS tespit edilenler Grup C ve bilateral kritik RAS tespit edilenler Grup D  olarak kabul edildi. Hasta grupları BNP düzeyleri açısından karşılaştırıldı.

Bulgular: Grup 1b hastalarda serum BNP ve serum kreatinin değerleri Grup 1a’ya göre daha yüksek saptandı (sırasıyla, p=0,003 ve p=0,015). Grup B hastaları A grubundakilere göre daha yüksek serum BNP düzeyleri ve daha düşük kreatinin klerensine sahiptiler (sırasıyla, p=0,025 ve p=0,041). Ayrıca D grubu hastalar C grubundakilerle karşılaştırıldığında yüksek serum BNP, kreatinin düzeyleri ve daha düşük kreatinin klerensine sahiptiler(sırasıyla, p=0,017,  p=0,006 ve p=0,049).

Sonuç: Çalışmamızın sonuçlarına göre yüksek serum BNP düzeylerinin renal anjiografi ile belirlenen RAS dereceleri ile anlamlı ilişkisi olduğunu göstermektedir. Bundan dolayı dirençli hipertansiyonu olan hastalarda RAS’ı tahmin etmede serum BNP düzeylerinin bir belirleyici olarak kullanılabilir.

Keywords

Beyin natriüretik peptit, renal arter stenozu, dirençli hipertansiyon

References

• Bloch MJ, Basile J:The diagnosis and management of renovascular disease: a primary care perspective. Part I. Making the diagnosis.J Clin Hypertens 2003;5(3):210-8.
• Bloch MJ, Basile J: Clinical insights into the diagnosis and management of renovascular disease. An evidence-based review.Minerva Med 2004;95(5):357-73.
• Zeller T: Percutaneous endovascular therapy of renal artery stenosis: technical and clinical developments in the past decade.J Endovasc Ther 2004;11 (2):96-106
• Dubel GJ, Murphy TP:The role of percutaneous revascularization for renal artery stenosis.Vasc Med 2008;13(2):141-56.
• Bloch MJ:An evidence-based approach to diagnosing renovascular hypertension.Curr Cardiol Rep 2001;3(6):477-84.
• Safley DM, McCullough PA:The emerging role of brain natriuretic peptide in the management of acute and chronic heart failure in outpatients. Heart Fail Monit 2003;4(1):13-20.
• Miasel AS: B-type natriüretic peptid (BNP) leves: diagnonostic and therapeutic potential. Rev Cardiovasc Med 2001;2: 13-8.
• Jensen KT, Carstens J, Ivarsen P, Pedersen EB: A new, fast and reliable radioimmunassay of brain natriüretic peptide in human plasma. Reference values in healty subjects and in patients with different diseases. Scand J Clin Lab Invest 1997; 57: 529-540.
• Wiese S, Breyer T, Dragu A, Wakili R, Burkard T, Schmidt-Schweda S, Füchtbauer EM, Dohrmann U,Beyersdorf F, Radicke D, Holubarsch CJ: Gene expression of brain natriuretic peptide in isolated atrial and ventricular myocardium: Influence of angiotensin II and diastolic fiber length. Circulation 2000;102:3074-3079
• Martinez-Maldonado M: Pathophysiology of renovascular hypertension. Hypertension 1991;17:707-719
• Nishimura M, Milsted A, Bloch CH, Brosnihan KB, Ferrario CM: Tissue renin-angiotensin systems in renal hypertension. Hypertension 1992;20:158-167
• Klassen PS, Svetkey LP:Diagnosis and managment os renovascular hypertension. Cardiology in Review 2000;8(1):17-29.
• Duygu H, Türk U, Zoghi M, Nalbantgil S. The Importance of plasma B-type natriuretic peptide levels in cardiovascular diseases. The Anatolian Journal of Cardiology 2005;5:305-11.
• Tsutamoto T, Horie M: [Brain natriuretic peptide]. Rinsho Byori. 2004;52(8):655-68
• From British Hypertension Society Technique of blood pressure measurment recommended by the British Hypertension Society. J Hypertens 1985; 3: 293.
• Preston RA, Epstein M:Ischemic renal disease: an emerging cause of chronic renal failure and end stage renal disease. J Hypertens 1997; 15: 1365-1377.
• van Ampting JM, Penne EL, Beek FJ, Koomans HA, Boer WH, Beutler JJ.:Prevalence ofatherosclerotic renal artery stenosis in patients starting dialysis. Nephrol Dial. Transplant 2003; 18(6): 1147-1151.
• Safian RD, Textor SC. Renal-artery stenosis. N Eng J Med 2001; 344: 431-442.
• Wright JR, Shurrab AE, Cheung C, Waldek S, O'Donoghue DJ, Foley RN, Mamtora H, Kalra PA: A prospective study of determinants of renal functional outcome and in mortality atherosclerotic renovascular disease. Am J Kidney Dis 2002; 39: 1153-1161
• Lai KN, Leung JC, Yandle TG, Fısher S, Nicholls MG. Gene expression and synthesis of natriüretic peptides by kultured human glomeruler cells. .J Hypertens 1999; 17: 575-583.
• Davidson NC, Naas AA, Hanson JK: Comparison of atriyal natriuretic peptide, BNP and N-terminal proatriyal natriuretic peptide indicators of left ventricular systolic dysfunction. Am J.Cardiol 1996; 77: 828-831.
• DeForrest JM, Knappenberger RC, Antonaccio MJ, Ferrone RA, Creekmore JS. Angiotensin II is a necessary component for the development of hypertension in the two kidney, one clip rat. Am J Cardiol 1982; 49: 1511–1517.
• Mussalo H, Vanninen E, Ikäheimo R, Hartikainen: NT-proANP and BNP inrenovascular and in severe and mild essential hypertension. Kidney Blood Pres Res 2003; 26 :34-41.
• Bettencourt P, Ferreira A, Sousa T, Ribeiro L, Brandão F, Polónia J, Cerqueira-Gomes M, Martins L: Brain natriuretic peptide as a marker of cardiac involvement in hypertension. Int J Cardiol. 1999;69(2):169-77.
• Silva JA, Chan AW, White CJ, Collins TJ, Jenkins JS, Reilly JP, Ramee SR:Elevated brain natriuretic peptide predicts blood pressure response after stent revascularization in patients with renal artery stenosis. Circulation 2005 25;111(3):328-33.
• Kurtz WK, Pfeifer M, Hochel K, Riegger GA, Kramer BK: Different regulation of left ventricular ANP, BNP and adrenomodullin mRNA in the two-kidney, one-clip model of renovascular hypertension. Pflugers Arch 2001; 442:212–217.
• Vickery S, Price CP, John RI, Abbas NA, Webb MC, Kempson ME, Lamb EJ: B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertophy. Am J Kidney Dis 2005;46(4):610-20.
• Tagore R, Ling LH, Yang H, Daw HY, Chan YH, Sethi SK. Natriuretic peptides in chronic kidney disease. Clin J Am Soc Nephrol 2008; 3(6):1644-51.
• Almirez R, Protter AA. Clearance of human brain natriuretic peptide in rabbits; effect of the kidney, the natriuretic peptide clearance receptor, and peptidase activity. J Pharmacol Exp Ther. 1999;289(2):976-80.
• Schou M, Dalsgaard MK, Clemmesen O, Dawson EA, Yoshiga CC, Nielsen HB, Gustafsson F, Hildebrandt PR, Secher NH:Kidney extract BNP in healty young men. Physiol 2005; (99):1676-1680.
• Khan IA, Fink J, Nass C, Chen H, Christenson R, de Filippi: CR.N-terminal pro-B-type natriuretic peptide for identifying coronary artery disease and left ventricular hypertrophy in ambulatory chronic kidney disease patients. Am J Cardiol 2006;(97):1530–1534.
• Tanemoto M, Saitoh H, Satoh F, Satoh H, Abe T, Ito S: Predictors of undiagnosed Renal artery stenosis among Japanese patients with risk factors of ateroscklerosis. Hypertens Res 2005; 28: 237-242.
• Park S, Jung JH, Seo HS, Ko YG, Choi D, Jang Y, Chung N, Cho SY, Shim WH. The prevalence and clinical predictors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography. Heart Vessels 2004;19: 275-279.
• Bianchi S, Bigazzi R, Campese VM:Microalbuminuria in essential hypertension J Nephrol 1997;10(4): 216-9.
• Asakawa H, Fukui T, Tokunaga K, Kawakami F:J Diabetes Complications. J Diabetes Complications 2002;16(3) :209-213.
• Igarashi M, Jimbu Y, Hirata A, Tominaga M:Characterization of plazma brain natriuretic peptide level in patients with type 2 diabetes. Endocr J 2005;52(3): 353-62.