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Cited by 13Cardiovascular Syncope and Autonomic DisordersHeart Failure Treatment and ManagementElectrolyte and hormonal disorders

Orthostatic hypotension of unknown cause: unanticipated association with elevated circulating N-terminal brain natriuretic peptide (NT-proBNP)

Krishnan, Balaji, Patarroyo-Aponte, Margarita, Duprez, Daniel, Pritzker, Marc, Missov, Emil, Benditt, David G.·2015·Heart Rhythm
DOI 10.1016/j.hrthm.2015.02.015
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Abstract

Background The pathophysiology of orthostatic hypotension (OH) is multifactorial, with the most frequent causes being adverse effects of cardioactive drugs. In 20%-40% of cases, the etiology is unknown. In recent reports, altered levels of endogenous neuropeptides have been observed in noncardiac syncope, but B-type natriuretic peptide (BNP) and its amino-terminal cleavage fragment (NT-proBNP) have not been studied.Objective The purpose of this study was to assess the possibility that BNP with its diuretic and vasorelaxant properties could contribute to OH.Methods This prospective observational study comprised 85 consecutive OH subjects (58 women, age 49 ± 23 years) referred to a tertiary-care syncope clinic. All patients had normal left ventricular systolic and diastolic function, and clinical and laboratory findings consistent with euvolemia or modest hypovolemia. In 45 of 85 individuals (53%), an OH cause was determined.Results Among the remaining 40 patients (21 women, age 57 ± 16 years) with OH of unknown cause, 6 of 40 (15%) exhibited unexpectedly elevated plasma NT-proBNP levels (14000, 5210, 2570, 7990, 3480, and 6680 pg/mL). In contrast, NT-proBNP values were normal (ie, <300 pg/mL) in the remaining 34 patients with OH of unknown cause and 45 patients with OH of known etiology. At 8 to 12 months of follow-up, volume repletion therapy requirements in patients with initial increased NT-proBNP diminished in conjunction with gradual fall of NT-proBNP concentrations.Conclusion In select patients, markedly elevated levels of BNP or NT-proBNP may be associated with and possibly contribute to symptomatic OH.

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  • Some cardiovascular biomarkers are increased in autonomic dysfunction underlying syncope, such as elevated copeptin (vasopressin), endothelin-1, and N-terminal pro-B-type natriuretic peptide in OH.

    “Some cardiovascular biomarkers are increased in autonomic dysfunction underlying syncope, such as elevated copeptin (vasopressin), endothelin-1, and N-terminal pro-B-type natriuretic peptide in OH, 113,230,231”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [230]

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Authors
Krishnan, B., Patarroyo-Aponte, M., Duprez, D., Pritzker, M., Missov, E., & Benditt, D. G.
Affiliations
University of Minnesota (US)
Corresponding author
Benditt, David G.
ORCID
Venue
Heart Rhythm
Publisher
Elsevier BV
Published
2015-06
Volume
12
Issue
6
Pages
1287-1294
ISSN
1547-5271 (ISSN-L)
DOI
10.1016/j.hrthm.2015.02.015
OpenAlex
W2134421994
Cited by
13
References
25
Citations by year
2024: 1 · 2023: 1 · 2022: 1 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 3
FWCI
2.01
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Heart Rhythm (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
Keywords
orthostatic hypotension, NT-proBNP, brain natriuretic peptide, syncope, unknown etiology, vasorelaxation, diuretic effect, endogenous neuropeptides
MeSH terms
Aged, Aged, 80 and over, Female, Cardiac Catheterization, Hemodynamics, Humans, Hypotension, Orthostatic, Male, Middle Aged, Prospective Studies, Tilt-Table Test, Natriuretic Peptide, Brain

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