Impact of Obesity on Plasma Natriuretic Peptide Levels
Abstract
Background— The mechanisms linking obesity to hypertension have not been established, but sodium retention and excessive sympathetic tone are key contributors. The natriuretic peptides are important regulators of sodium homeostasis and neurohormonal activation, raising the possibility that obese individuals have an impaired natriuretic peptide response. Methods and Results— We examined the relations of plasma B-type natriuretic peptide (BNP) and N-terminal proatrial natriuretic peptide (N-ANP) to body mass index in 3389 Framingham Study participants (1803 women) without heart failure. Multivariable regression analyses were performed, adjusting for clinical and echocardiographic covariates. BNP levels below the assay detection limit and N-ANP levels in the lowest sex-specific quartile were categorized as low. Multivariable-adjusted mean plasma BNP levels in lean (<25 kg/m 2 ), overweight (25 to 29.9 kg/m 2 ), and obese (≥30 kg/m 2 ) men were 21.4, 15.5, and 12.7 pg/mL, respectively (trend P <0.0001). Corresponding values in women were 21.1, 16.3, and 13.1 pg/mL (trend P <0.001). A similar pattern was noted for plasma N-ANP. Obese individuals had higher odds of having low plasma BNP (multivariable-adjusted odds ratios: men, 2.51; 95% CI, 1.71 to 3.68; women, 1.84; 95% CI, 1.32 to 2.58) and low plasma N-ANP (odds ratios: men, 4.81; 95% CI, 2.98 to 7.76; women, 2.85; 95% CI, 2.01 to 4.04) compared with lean individuals. Diabetes also was associated with low plasma natriuretic peptide levels, and the negative effects of obesity and diabetes on natriuretic peptide levels were additive. Conclusions— Obese individuals have low circulating natriuretic peptide levels, which may contribute to their susceptibility to hypertension and hypertension-related disorders.
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Increased natriuretic peptide levels are associated with CVD and early heart failure, whereas overweight and insulin resistance decrease ANP levels.
“Increased levels of the NPs are associated with CVD and early heart failure (9), but in contrast large cohort studies have shown that overweight and insulin resistance decrease levels of ANP (10).”
From Effect of liraglutide on atrial natriuretic peptide, adrenomedullin, and copeptin in PCOS (2018) · cites this paper as [10]
In the Framingham Heart Study, participants with obesity had lower circulating amino-terminal pro-ANP concentrations than those with normal BMI.
“In the Framingham Heart Study, participants with obesity had lower circulating amino-terminal pro-ANP concentrations than those who had normal BMI93.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [93]
Levels of natriuretic peptides are inappropriately low in obese subjects, and their release in response to volume loading is impaired.
“Not only are levels of natriuretic peptides inappropriately low in obese subjects23, but their release in response to volume loading is impaired24.”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [23]
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- Authors
- Wang, T. J., Larson, M. G., Levy, D., Benjamin, E. J., Leip, E. P., Wilson, P. W. F., & Vasan, R. S.
- Affiliations
- Boston University (US)
- ORCID
- Venue
- Circulation
- Published
- 2004-02-10
- Volume
- 109
- Issue
- 5
- Pages
- 594-600
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2057501387
- Cited by
- 1,022
- References
- 36
- Citations by year
- 2026: 24 · 2025: 48 · 2024: 43 · 2023: 40 · 2022: 36 · 2021: 45 · 2020: 53 · 2019: 43 · 2018: 56 · 2017: 54 · 2016: 55 · 2015: 52 · 2014: 45 · 2013: 45 · 2012: 49
- FWCI
- 34.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k23hl074077-03, n01hc25195-41-0-1, NO1-HC-25195)
- National Heart, Lung, and Blood Institute (K23 HL074077-01, K-24-HL-04334, N01‐HC25195, K24HL004334, NO1‐HC‐25195)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- obesity, natriuretic peptides, brain natriuretic peptide, N-terminal proatrial natriuretic peptide, body mass index, hypertension, sodium homeostasis, diabetes mellitus, sympathetic nervous system, Framingham Heart Study
- MeSH terms
- Body Constitution, Female, Humans, Hypertension, Male, Middle Aged, Atrial Natriuretic Factor, Obesity, Protein Precursors, Body Mass Index, Natriuretic Peptide, Brain, Diabetes Complications
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