Determination of Brain Natriuretic Peptide as a diagnostic factor for Urgent Hypertension in Patients with Hypertension; a Prospective Study in Patients Referring to the Emergency Department of Adalatian Hospital in Mashhad
Iranian Journal of Emergency Medicine,
Vol. 9 No. 1 (2022),
16 March 2022
,
Page e20
https://doi.org/10.22037/ijem.v9i1.38606
Abstract
Introduction: BNP increases in certain pathological conditions such as hypertension, renal failure, myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), cirrhosis, etc. Some of them are among the clinical conditions pointing to hypertensive emergency and also its side effects. Therefore, in this study, we aimed to investigate the effeciency of this variable as a diagnostic variable in patients with emergency hypertension.
Methods: In this prospective study, 100 patients presenting to the emergency center of Adalatian Hospital, Mashhad, Iran, who had blood pressure equal to or greater than 180/110 mmHg at the time of triage and initial visit were included in the study. In order to evaluate damage to the target organs and the possible diagnosis of emergency hypertension, they were examined by an emergency medicine specialist or resident and the necessary tests were performed. For this purpose, serum levels of blood urea nitrogen (BUN), creatinine (Cr), and TPI/Immune thrombocytopenic purpura (ITP) were checked and a complete neurological examination was performed on patients to determine the presence of focal or generalized neurological defects or the presence of pathology (intracerebral hemorrhage (ICH), ischemia) on brain computed tomography (CT) scan. Patients' eyes were also examined for retinal vascular damage with an ophthalmoscope, and electrocardiogram (ECG) was also taken. Patients were divided into two groups based on the results: emergency hypertension and non-emergency hypertension. Meaning, if the criteria for emergency hypertension (target organ damage) were met, they were placed in the end organ dysfunction (EOD) group or hypertensive emergency (HE) group, and otherwise, they were placed in the group without EOD or hypertensive urgency (HU) group. Data analysis was performed using SPSS version 16 and descriptive and inferential statistics tests.
Results: There was no statistically significant difference between the two groups in terms of age and gender (P> 0.05). Based on the tests performed on samples taken from the patients, in the case group BNP level was 6144.81 ± 3052.42 pg/mL and in the control group it was 4835.42 ± 3135.02 pg/mL. The results of T test showed that there was no statistically significant difference between the two groups (P = 0.941). Based on calculations performed, at the cut-off point of 180, BNP can predict kidney damage with 100% sensitivity and 41% specificity. Although specificity and positive predictive value are not high at this cut-off point, but sensitivity and negative predictive value are acceptable, which makes it suitable for screening.
Conclusion: The results of our study showed that BNP test did not have high specificity or positive predictive value, but it had acceptable sensitivity and negative predictive value, which makes it suitable for screening. Therefore, this test can be used as a supplement to other examinations and cardiovascular and renal tests.
- Hypertension
- emergencies
- natriuretic peptide, brain
How to Cite
References
Ramsay LE, Williams B, Johnston GD, MacGregor GA. British Hypertention Society guidelines for hypertension management 1999: Summary. British Medical Journal. 1999;319(7210):630.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. The lancet. 2005;365(9455):217-23.
Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation. 2005;112(11):1651-62.
Giles TD, Materson BJ, Cohn JN, Kostis JB. Definition and classification of hypertension: an update. J Clin Hypertens (Greenwich). 2009 Nov;11(11):611-4.
Prisant LM, Weir MR, Papademetriou V, Weber MA, Adegbile IA, Alemayehu D, et al. Low-dose drug combination therapy: an alternative first-line approach to hypertension treatment. American heart journal. 1995;130(2):359-66.
Chalmers J, Zanchetti A. The 1996 report of a World Health Organization expert committee on hypertension control. Journal of hypertension. 1996;14(8):929-34.
razazian N, Mohammadi M, Tahmasebi S, Esmaili O. Evaluation of Cerebral Venous Thrombosis Patients in Kermanshah (2002-2008). 2013. 2013 2013-03-05;16(8):4.
Nazemi P, Safavi E, Bagherzadeh A, Taslimi R, Mirzaii-Dizgah I. Relationships of serum troponin T with ECG, colour doppler sonography of lower extremity venous and arterial blood gas findings in patients with acute pulmonary embolism. koomesh. [Research]. 2012;13(3):286-92.
Zobeiri M, Hajiabadi A, Rezaei M. Plasma Homocystein elevelsin subjects with Deep Vein Thrombosis (DVT) and non- DVT. 2012. 2012 2012-09-16;16(4):6.
Buckley M, Markandu N, Miller M, Sagnella G, MacGregor G. Plasma concentrations and comparisons of brain and atrial natriuretic peptide in normal subjects and in patients with essential hypertension. Journal of human hypertension. 1993;7(3):245-50.
El Maraghi S et al. B-type natriuretic peptide in hypertensive crises: Diagnostic use in hypertensive urgencies and emergencies, Egypt J Crit Care Med (2013), http://dx.doi.org/10.1016/j.ejccm.2013.01.002
Kato J, Kitamura K, Matsui E, Tanaka M, Ishizaka Y, Kita T, et al. Plasma adrenomedullin and natriuretic peptides in patients with essential or malignant hypertension. Hypertension Research. 1999;22(1):61-5.
Balci B, Yilmaz O, Yesildag O. The influence of ambulatory blood pressure profile on left ventricular geometry. Echocardiography. 2004 Jan;21(1):7-10.
Davila DF, Donis JH, Odreman R, Gonzalez M, Landaeta A. Patterns of left ventricular hypertrophy in essential hypertension: should echocardiography guide the pharmacological treatment? International journal of cardiology. 2008 Feb 29;124(2):134-8.
Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. Journal of the American College of Cardiology. 1992 Jun;19(7):1550-8.
Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Annals of internal medicine. 1999;131(8):564-72.
Selenta C, Hogan BE, Linden W. How often do office blood pressure measurements fail to identify true hypertension?: an exploration of white-coat normotension. Archives of Family Medicine. 2000;9(6):533.
Angeli F, Reboldi G, Verdecchia P. Masked hypertension: evaluation, prognosis, and treatment. American journal of hypertension. 2010;23(9):941-8.
Papadopoulos DP, Makris TK. Masked hypertension definition, impact, outcomes: a critical review. The Journal of Clinical Hypertension. 2007;9(12):956-63.
Deeks JJ. Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001 Jul 21;323(7305):157-62.
Motamedi MR, Komeili Birjandi R, Saadat H, Namazi MH, Safi M, Vakili H, et al. Diagnostic Value of NT-BroBNP in HF Patients Admitted with Dyspnea in Emergency Department. Pajoohandeh Journal. [Original]. 2010;14(5):241-5.
Saadatnia M, Najafi MR, Farshadmehr A, Sadeghiyeh SM. Plasma Levels of Brain Natriuretic Peptide: A Comparison between Vascular Dementia Patients and Stroke Patients without Dementia. Journal of Isfahan Medical School. 2012;30(177).
- Abstract Viewed: 196 times
- pdf (فارسی) Downloaded: 119 times