NT-proBNP Predicts Kidney Function Changes on Anti-Hypertensive Therapy

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Patients who have decreased levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) during hypertension treatment are at lower risk of subsequent decline in kidney function, according to the American Journal of Kidney Diseases.

The prospective observational study included data on 8005 patients with hypertension from the Systolic Blood Pressure Intervention Trial (SPRINT). In that study, patients were randomly assigned to “intensive” (120 mm Hg) or “standard” (140 mm Hg) systolic blood pressure targets.

Patients with diabetes and proteinuria greater than 1 g/day were excluded from the trial. In the main SPRINT results, the intensive treatment target was associated with lower risk of major cardiovascular events and death but increased rates of certain adverse events.

In the new analysis, patients were classified as having a 1-year increase or decrease in NT-proBNP (≥25%) or stable NT-pro-BNP (<25% in either direction). Associations with change in kidney function were compared between groups, with stratification by chronic kidney disease (CKD) status.

Patients with a 25% or greater decrease in NT-proBNP had a slower decline in kidney function. An adjusted difference in estimated glomerular filtration rate (eGFR) was 1.09% per year among patients with CKD versus 0.51% per year in those without CKD. In contrast, patients with baseline CKD receiving treatment who had an increase in NT-proBNP showed a faster decline in eGFR: adjusted difference, 1.04% per year. Patients with CKD with increased NT-proBNP were also more likely to have a 30% or greater decline in eGFR: adjusted odds ratio, 1.44. The impact was similar in patients assigned to intensive versus standard blood pressure targets.

“Changes in NT-proBNP during blood pressure treatment are independently associated with subsequent kidney function decline, particularly in people with CKD,” the investigators conclude. They discuss the potential implications for dynamic monitoring of NT-proBNP for assessing kidney risk during anti-hypertensive therapy [Ascher SB, et al. Changes in natriuretic peptide levels and subsequent kidney function decline in the SPRINT trial. Am J Kidney Dis, published online November 20, 2023. doi: 10.1053/j.ajkd.2023.09.018].