We tested our hypothesis that the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiovascular disease (CVD) events is mediated in part by a pathway of increased nighttime blood pressure (BP) that involves volume overload. We used the data from the Japan Morning Surge-Home Blood Pressure (J-HOP) Nocturnal BP Study, which targeted 2476 Japanese participants who had a history of or risk for CVD (mean age 63.8 ± 10.2 years), along with their measured nighttime BP values assessed by a home BP device (measured at 2:00, 3:00 and 4:00 a.m.) and NT-proBNP levels. At baseline, elevated daytime (average of morning and evening) and nighttime home systolic BP (SBP) were independently associated with log-transformed NT-proBNP levels after adjustment for cardiovascular risk factors. During a median follow-up of 7.2 years, 150 participants experienced a CVD event (62 stroke events and 88 coronary artery disease events). After adjustment for cardiovascular risk factors and nighttime SBP, increased log-transformed NT-proBNP levels were independently associated with CVD events (hazard ratio [HR] per 1 unit, 1.67; 95% confidence interval [CI]: 1.16–2.40). Elevated nighttime home SBP was also independently associated with CVD events after adjustment for cardiovascular risk and log-transformed NT-proBNP (HR per standard deviation, 1.22; 95% CI: 1.001–1.50). The percentage of the association between NT-proBNP and CVD events mediated by nighttime home SBP was 15%. Our findings indicate a physiological pathway in which increased nighttime SBP contributes to the impact of elevated NT-proBNP levels on the incidence of CVD.

我们检验了我们的假设，即 N 端脑利钠肽前体 (NT-proBNP) 与心血管疾病 (CVD) 事件之间的关联部分是由涉及容量超负荷的夜间血压 (BP) 升高通路介导的。我们使用了来自日本晨间血压（J-HOP）夜间血压研究的数据，该研究针对 2476 名有 CVD 病史或风险的日本参与者（平均年龄 63.8 ± 10.2 岁），以及他们测量的夜间通过家用 BP 设备评估的 BP 值（在凌晨 2:00、3:00 和 4:00 测量）和 NT-proBNP 水平。在基线时，在调整心血管危险因素后，升高的白天（早上和晚上的平均值）和夜间家庭收缩压 (SBP) 与对数转换的 NT-proBNP 水平独立相关。在 7.2 年的中位随访期间，150 名参与者经历了 CVD 事件（62 次中风事件和 88 次冠状动脉疾病事件）。在调整心血管危险因素和夜间 SBP 后，对数转换后的 NT-proBNP 水平升高与 CVD 事件独立相关（风险比 [HR] 每 1 个单位，1.67；95% 置信区间 [CI]：1.16-2.40）。在调整心血管风险和对数转换的 NT-proBNP 后，夜间家庭 SBP 升高也与 CVD 事件独立相关（HR/标准差，1.22；95% CI：1.001-1.50）。NT-proBNP 与夜间家庭 SBP 介导的 CVD 事件之间的关联百分比为 15%。我们的研究结果表明夜间 SBP 增加有助于 NT-proBNP 水平升高对 CVD 发病率的影响的生理途径。