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A Clinical Prediction Model for Selective NT-proBNP Testing in Hypertension.

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Τίτλος: A Clinical Prediction Model for Selective NT-proBNP Testing in Hypertension.
Συγγραφείς: Cai A; Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.; Department of Cardiology, People's Hospital of Yingde City, Yingde, Guangdong Province, China., Liu L; Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China., Yu X; Department of Cardiology, People's Hospital of Yingde City, Yingde, Guangdong Province, China., Wu D; Department of Cardiology, People's Hospital of Yingde City, Yingde, Guangdong Province, China., Lin X; Department of Cardiology, People's Hospital of Yingde City, Yingde, Guangdong Province, China., Luo S; Department of Cardiology, People's Hospital of Yingde City, Yingde, Guangdong Province, China., Liu K; Department of Cardiology, People's Hospital of Yingde City, Yingde, Guangdong Province, China.
Πηγή: Journal of clinical hypertension (Greenwich, Conn.) [J Clin Hypertens (Greenwich)] 2026 Jun; Vol. 28 (6), pp. e70310.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley Periodicals Inc Country of Publication: United States NLM ID: 100888554 Publication Model: Print Cited Medium: Internet ISSN: 1751-7176 (Electronic) Linking ISSN: 15246175 NLM ISO Abbreviation: J Clin Hypertens (Greenwich) Subsets: MEDLINE
Imprint Name(s): Publication: : [Hoboken, NJ] : Wiley Periodicals Inc.
Original Publication: Greenwich, CT : Le Jacq Communication, Inc., c1999-
Ιατρικοί όροι (MeSH): Natriuretic Peptide, Brain*/blood , Natriuretic Peptide, Brain*/analysis , Hypertension*/blood , Hypertension*/diagnosis , Hypertension*/epidemiology , Hypertension*/physiopathology , Hypertension*/complications , Peptide Fragments*/blood , Peptide Fragments*/analysis , Heart Failure*/diagnosis , Heart Failure*/epidemiology , Heart Failure*/blood, Biomarkers/blood ; United States/epidemiology ; Blood Pressure/physiology ; Humans ; Male ; Female ; Middle Aged ; Nutrition Surveys ; Adult ; Aged ; Predictive Value of Tests ; Risk Factors ; Prediction Algorithms
Περίληψη: N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is recommended for pre-heart failure (pre-HF) screening. However, universal NT-proBNP testing is infeasible and inefficient. We analyzed data from 4642 U.S. adults with hypertension in NHANES 1999-2004. Heart stress, a biomarker-defined pre-HF state, was defined using age-specific NT-proBNP cutoffs. Multivariable logistic regression was used to identify factors associated with prevalent heart stress, and a point-based score was constructed. Model discrimination and calibration were internally validated using 1000 bootstrapped samples. Heart stress was present in 31% of individuals with hypertension. Factors associated with heart stress included older age, current smoking, prior coronary heart disease/myocardial infarction, higher systolic blood pressure, lower diastolic blood pressure, and reduced estimated glomerular filtration rate. The derivation model showed acceptable discrimination (AUC 0.71; 95% CI 0.70-0.73) and good calibration. An optimal cutoff of 6 points was identified using the Youden index and was internally validated (AUC 0.71; 95% CI 0.69-0.74). Model performance was consistent across race/ethnicity and body mass index subgroups, with relatively lower discrimination in females than in males (AUC 0.66 vs. 0.78). When stratified by a predicted heart stress probability threshold of 50%, individuals in the higher-probability group had higher cumulative risk of all-cause (hazard ratio 3.90; 95% CI 3.55-4.29) and cardiovascular mortality (hazard ratio 5.18; 95% CI 4.44-6.04) than those in the lower-probability group. These findings suggest that a simple model using readily obtainable clinical variables can help identify individuals with hypertension who are likely to have prevalent heart stress, offering a practical strategy to guide selective NT-proBNP testing.
(© 2026 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)
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Contributed Indexing: Keywords: biomarker; discrimination; hypertension; mortality; screening
Substance Nomenclature: 114471-18-0 (Natriuretic Peptide, Brain)
0 (pro-brain natriuretic peptide (1-76))
0 (Peptide Fragments)
0 (Biomarkers)
Entry Date(s): Date Created: 20260619 Date Completed: 20260619 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13280469
DOI: 10.1111/jch.70310
PMID: 42317108
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1751-7176
DOI:10.1111/jch.70310