Natriuretic Peptide Levels and Race

Study Questions:

What is the impact of race/ethnicity on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels?

Methods:

The investigators examined plasma NT-proBNP levels according to race/ethnicity in 3,148 individuals (51% black, 31% white, 18% Hispanic) free of prevalent cardiovascular disease in the Dallas Heart Study. NT-proBNP values in the bottom sex-specific quartile were defined as low. Multivariable linear and logistic regression analyses were performed, adjusting for clinical covariates and magnetic resonance imaging measurements of cardiac structure and function.

Results:

Hypertension was present in 41%, 25%, and 16% of black, white, and Hispanic individuals, respectively. Unadjusted NT-proBNP levels were lowest in black (median: 24 pg/ml; interquartile range [IQR], 10-52 pg/ml) as compared with Hispanic (30 pg/ml; IQR, 14-59 pg/ml) and white individuals (32 pg/ml; IQR, 16-62 pg/ml), p < 0.0001. In multivariable-adjusted models, black individuals still had significantly lower NT-proBNP levels (-39% [95% confidence interval, -46% to -31%]; p < 0.0001) and greater odds of having low NT-proBNP (odds ratio, 2.46 [95% confidence interval, 1.86-3.26]), compared with white individuals. In contrast, NT-proBNP levels did not significantly differ between Hispanic and white individuals (p = 0.28). The finding of lower NT-proBNP levels in black individuals was similar when analyses were restricted to healthy participants without cardiovascular risk factors.

Conclusions:

The authors concluded that NT-proBNP levels differ substantially according to race/ethnicity.

Perspective:

This population-based, multiethnic study reports that black individuals have considerably lower plasma natriuretic peptide levels than white individuals. These findings support the hypothesis that black race is associated with a ‘relative deficiency’ in natriuretic peptides and raises the possibility that a blunted natriuretic peptide system might contribute to the increased susceptibility to hypertension and related disorders in blacks. The natriuretic peptide system may represent a target for the prevention and treatment of cardiovascular disease, particularly in black individuals, and merits further study.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Magnetic Resonance Imaging, Hypertension

Keywords: African Americans, Biological Markers, Heart Failure, Hispanic Americans, Hypertension, Magnetic Resonance Imaging, Natriuretic Peptide, Brain, Natriuretic Peptides, Peptide Fragments, Primary Prevention, Risk Factors


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