The effects of central arterial pressure and autonomic dysfunction on elevations in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in men with diabetes

Abstract

Background: In diabetes, left ventricular dysfunction independent of coronary disease is common and is associated with elevations in NT-proBNP. Our aims were to determine the relative importance of central aortic pressure, cardiovascular autonomic function and arterial stiffness as predictors of elevated NT-proBNP. Methods: Fifty males with diabetes mellitus and 21 males with IGT were studied. Arterial stiffness and wave reflections were assessed by measuring aortic and brachial pulse wave velocity (PWV) and augmentation index (AIX). Cardiovascular autonomic function was assessed by measurements of heart rate variability following standard manoeuvres. Results: Comparing diabetes versus IGT subjects (mean ± SD), both aortic PWV (9.7 ± 2.4 versus 8.2 ± 1.4 m/s, p < 0.01) and cardiovascular autonomic dysfunction (autonomic score 2.3 ± 1.3 versus 1.6 ± 1.0, p < 0.01) were greater in diabetes subjects. NT-proBNP levels correlated with central and brachial systolic pressure (r = 0.74, p < 0.0001 and r = 0.66, p < 0.0001, respectively), aortic PWV (r = 0.43, p < 0.01), AIX (r = 0.55, p < 0.0001), and autonomic function (r = 0.37, p < 0.01). Multiple regression analysis amongst diabetic subjects showed central systolic blood pressure to be the strongest predictor of NT-proBNP concentrations. Conclusions: Elevated central arterial pressure is a strong predictor of NT-proBNP concentrations in diabetic men without clinically apparent left ventricular dysfunction. This is indicative of the key influence of unfavourable large artery haemodynamics on the development of left ventricular dysfunction in diabetes.

Keywords

• Arterial stiffness
• Augmentation index
• Autonomic neuropathy
• NT-proBNP