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. 2024 Nov 8:55:101549.
doi: 10.1016/j.ijcha.2024.101549. eCollection 2024 Dec.

The role of NT-proBNP in screening for atrial fibrillation in hypertensive disease

Gina Sado  1   2 , Katrin Kemp Gudmundsdottir  3 , Carl Bonander  4 , Mattias Ekström  3   2 , Johan Engdahl  3   2 , Emma Svennberg  1
Affiliations

The role of NT-proBNP in screening for atrial fibrillation in hypertensive disease

Gina Sado et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Atrial fibrillation (AF) screening should be considered in elderly patients with high risk of stroke, which include individuals with hypertension. The biomarker N-terminal prohormone of brain natriuretic peptide (NT-proBNP) can predict incident AF and is increased in hypertensive individuals. The aim of this study is to investigate the incidence of screening-detected AF in elderly individuals in relation to NT-proBNP and hypertension.

Methods: STROKESTOP II is a randomized controlled trial in which 75/76-years-old individuals were invited to a screening study for AF using NT-proBNP as a discriminator of high risk. In this sub-study, a prior hypertension diagnosis was self-reported by participants and measured blood pressure was stratified into hypertension-grades. Individuals with both increased blood pressure (≥140 mmHg) and NT-proBNP ≥ 125 ng/L were defined as a high-risk group. The lowest risk-group was defined as normotensive participants with NT-proBNP < 125 ng/L.

Results: NT-proBNP increased gradually for every hypertension-grade above hypertension-grade 1 compared to normotensive participants. Screening-detected AF was most common in normotensive participants with increased NT-proBNP (n = 90/1922, 4.7 %), followed by patients with both NT-proBNP > 125 ng/l and SBP ≥ 140 mmHg, (AF = 65/1741, 3.7 %) compared to the low-risk group (AF = 2/1444, 0.1 %), p < 0.001.

Conclusion: NT-proBNP is elevated in elderly patients with hypertension and increases with grades of hypertensive disease. NT-proBNP is a strong predictor of AF regardless of high blood pressure, and the risk for screening-detected AF is very low in participants with normal blood pressure and low NT-proBNP. A combination of blood pressure and NT-proBNP could identify suitable participants for AF screening.

Keywords: Atrial fibrillation; Blood pressure; Hypertension; Hypertension grades; Mass screening; NT-proBNP.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: GS reports no disclosures. KKG has received research grants from Roche Diagnostics and the Swedish Heart Lung Foundation and lecture fees from Roche Diagnostics and Boehringer Ingelheim. ME reports lecture/consulting fees from Amarin, Amgen, Sanofi AB and research grants from Novartis foundation from medical-biological research. JE has received consultant or lecture fees from Roche Diagnostics, Pfizer, Bristol Myers Squibb, Boehringer Ingelheim, Piotrode and Philips, and research grants from the Swedish Research Council, The Swedish Heart Lung Foundation, The Swedish Innovation Agency, and The Stockholm Region. ES reports lecture/consulting fees (institutional) from Abbott, Astra Zeneca, Bristol-Myers Squibb-Pfizer and Johnson & Johnson. CB and GS reports no COI.

Figures

Fig. 1A
Fig. 1A
Boxplots of Median NT-proBNP levels in hypertension/non-hypertension ± AF. Some outliers were not shown (total NT-proBNP > 1000 ng/L, n = 82 in both groups). AF, atrial fibrillation; HTN, hypertension; non-HTN, non-hypertension; NT-proBNP, N-terminal pro-B-type natriuretic peptide.
Fig. 1B
Fig. 1B
Boxplots of median NT-proBNP levels in hypertension-grades according to ESC Guidelines ± incident AF. Some outliers of NT-proBNP were not shown in HTN-grades ± AF (total NT-proBNP > 1000 ng/L, n = 82 in both groups). Normal BP(<140 mmHg), Grade 1 HTN (140–159 mmHg), Grade 2 HTN (160–179 mmHg), Grade 3 HTN (≥180 mmHg). AF, atrial fibrillation; HTN, hypertension; non-HTN, non-hypertension; NT-proBNP; N-terminal pro-B-type natriuretic peptide; BP, blood pressure.
See this image and copyright information in PMC

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