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Nighttime home blood pressure as a mediator of N-terminal pro-brain natriuretic peptide in cardiovascular events

Hypertension Research volume 44, pages 1138–1146 (2021)Cite this article

Abstract

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.

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Acknowledgements

We thank all of the participants and investigators involved in the J-HOP study.

Funding

This study was financially supported in part by a grant from the 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science, and Technology (to KK); a grant from the Foundation for Development of the Community (Tochigi, Japan); and a grant from Omron Healthcare, Co., Ltd.; a Grant-in-Aid for Scientific Research (B) (21390247) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, 2009–2013; and funds from the MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2011–2015 Cooperative Basic and Clinical Research on Circadian Medicine (S1101022).

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  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan

    Satoshi Hoshide & Kazuomi Kario

  2. Genki Plaza Medical Center for Health Care, Tokyo, Japan

    Hiroshi Kanegae

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Correspondence to Kazuomi Kario.

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KK has received research grants from Omron Healthcare and A&D Co. The other authors have no competing interests to declare.

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Hoshide, S., Kanegae, H. & Kario, K. Nighttime home blood pressure as a mediator of N-terminal pro-brain natriuretic peptide in cardiovascular events. Hypertens Res 44, 1138–1146 (2021). https://doi.org/10.1038/s41440-021-00667-5

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