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Central pulse pressure links microalbuminuria with plasma B-type natriuretic peptide elevation: causal implication for cardiorenal syndrome in hypertension

Hashimoto, Junichiroa; Ito, Sadayoshib

Journal of Hypertension:
doi: 10.1097/HJH.0000000000000242

Objective: A pathological connection between the heart and kidney is well recognized as a cardiorenal syndrome, but the underlying mechanism remains undetermined. We hypothesized that this connection is attributable to central haemodynamic alterations.

Methods: In 386 patients with hypertension, the radial, carotid and femoral pressure waveforms were recorded with applanation tonometry to estimate the aortic pressure and pulse wave velocity (PWV). The plasma B-type natriuretic peptide (BNP) concentration and urinary albumin/creatinine ratio (UACR), cardiac and renal damage biomarkers, respectively, were also measured for each patient.

Results: The BNP was correlated positively with UACR, aortic pulse pressure and PWV, but inversely with the estimated glomerular filtration rate (eGFR, P < 0.001). The aortic pulse pressure tended to more closely correlate with BNP than the brachial pulse pressure. The presence of (micro)albuminuria (UACR ≥30 mg/g) was associated with BNP elevation (≥50 pg/ml) independently of age, BMI, mean arterial pressure, eGFR and β-blocker treatment (odds ratio: 2.41; P = 0.04). However, further adjustment for the aortic pulse pressure or PWV rendered this albuminuria–BNP relationship insignificant (P = 0.25) and, instead, the aortic pulse pressure emerged as the strongest determinant of BNP elevation (odds ratio: 1.51 per 10mmHg; P = 0.001). Differently from albuminuria, lower eGFR was consistently related to higher plasma BNP, even after controlling for the aortic pressure and PWV.

Conclusion: Concomitant plasma BNP elevation with (micro)albuminuria can be explained by increases in aortic pulse pressure and PWV. This finding suggests that the altered central haemodynamics causes simultaneous damage/dysfunction in the heart and kidney, which could then contribute to cardiorenal syndrome in hypertension.

Author Information

aDepartment of Blood Pressure Research

bDivision of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

Correspondence to Junichiro Hashimoto, MD, PhD, Department of Blood Pressure Research, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan. Tel: +81 22 717 7163; fax: +81 22 717 7168; e-mail:

Abbreviations: AIx, augmentation index; BNP, B-type natriuretic peptide; CKD, chronic kidney disease; CRS, cardiorenal syndrome; eGFR, estimated glomerular filtration rate; MAP, mean arterial pressure; NYHA, New York Heart Association; PP, pulse pressure; PWV, pulse wave velocity; PWVCF, carotid-femoral pulse wave velocity; PWVCR, carotid-radial pulse wave velocity; UACR, urinary albumin/creatinine ratio

Received 9 January, 2014

Revised 9 January, 2014

Accepted 9 January, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins