Background: Obesity and hypertension are often comorbid, but the pathophysiologic mechanisms that link them are not fully understood. Natriuretic peptides might play a role in this association. The majority of studies show lower brain natriuretic peptide (BNP) concentrations as well as lower concentrations of the N-terminal of the prohormone (NT-proBNP) in obese than normal body mass index (BMI) adults and higher BNP concentrations in hypertensive than in normotensive individuals. In children, there are no studies examining the relations between NT-proBNP, BMI and blood pressure. Materials and Methods: Ninety-six children, 24 obese/25 normal BMI boys, and 23 obese/24 normal BMI girls, aged 10–16 years, were studied. Plasma NT-proBNP was measured using electrochemiluminescence. Results: In males, NT-proBNP concentrations were lower in the obese than the normal BMI group but higher in the obese hypertensive than the obese normotensive group (p = 0.04). In addition, a significant positive correlation was noted between plasma NT-proBNP and blood pressure (p = 0.03) only in obese males. In females, no correlations were detected between NT-proBNP, BMI and systolic or diastolic blood pressure. Conclusions: Longitudinal studies are needed to define the role of NT-proBNP as a screening biomarker in obese children, particularly males, to determine their risk for developing arterial hypertension.

Keywords:
NT-proBNP, Puberty, Body mass index, Gender
1.
Hall JE: The kidney, hypertension, and obesity. Hypertension 2003;41:625–633.
2.
Dessi-Fulgheri P, Sarzani R, Tamburrini P, Moraca A, Espinosa E, Cola G, Giantomassi L, Rappelli A: Plasma atrial natriuretic peptide and natriuretic peptide receptor gene expression in adipose tissue of normotensive and hypertensive obese patients. J Hypertens 1997;15:1695–1699.
3.
Rocchini AP, Key J, Bondie D, Chico R, Moorehead C, Katch V, Martin M: The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. N Engl J Med 1989;321:580–585.
4.
Pervanidou P, Chrousos GP: Brain natriuretic peptide (BNP); in Fink G (ed): Encyclopedia of Stress, ed 2. Oxford, Academic Press, 2007, vol 1, pp 357–360.
5.
Suttner SW, Boldt J: Natriuretic peptide system: physiology and clinical utility. Curr Opin Crit Care 2004;10:336–341.
6.
Hall C: NT-ProBNP: the mechanism behind the marker. J Card Fail 2005;11(suppl):S81–S83.
7.
Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M: Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 1998;135:825–832.
8.
Worster A, Balion CM, Hill SA, Santaguida P, Ismaila A, McKelvie R, Reichert SM, McQueen MJ, Booker L, Raina PS: Diagnostic accuracy of BNP and NT-proBNP in patients presenting to acute care settings with dyspnea: a systematic review. Clin Biochem 2008;41:250–259.
9.
McCord J, Mundy BJ, Hudson MP, Maisel AS, Hollander JE, Abraham WT, Steg PG, Omland T, Knudsen CW, Sandberg KR, McCullough PA; Breathing Not Properly Multinational Study Investigators: Relationship between obesity and B-type natriuretic peptide levels. Arch Intern Med 2004;164:2247–2252.
10.
Iwanaga Y, Kihara Y, Niizuma S, Noguchi T, Nonogi H, Kita T, Goto Y: BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship. J Card Fail 2007;13:663–667.
11.
Taylor JA, Christenson RH, Rao K, Jorge M, Gottlieb SS: B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures. Am Heart J 2006;152:1071–1076.
12.
Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Wilson PW, Vasan RS: Impact of obesity on plasma natriuretic peptide levels. Circulation 2004;109:594–600.
13.
Mir TS, Laux R, Hellwege HH, Liedke B, Heinze C, von Buelow H, Läer S, Weil J: Plasma concentrations of N-terminal brain natriuretic peptide in healthy children, adolescents and young adults: effect of age and gender. Pediatrics 2003;112:896–899.
14.
Chiotis D, Krikos X, Tsiftis G, Hatzisymeaon M, Maniati-Christidi M, Dacou-Voutetakis A: Body mass index and prevalence of obesity in subjects of Hellenic origin aged 0–18 years, living in the Athens area. Ann Clin Pediatr Univ Atheniensis 2004;51:139–154.
15.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555–576.
16.
Tanner JM: Growth at Adolescence, ed 2. Oxford, Blackwell Scientific Publications, 1962.
17.
Nir A, Bar-Oz B, Perles Z, Brooks R, Korach A, Rein AJ: N-terminal pro-B-type natriuretic peptide: reference plasma levels from birth to adolescence. Elevated levels at birth and in infants and children with heart diseases. Acta Paediatr 2004;93:603–607.
18.
Schwachtgen L, Herrmann M, Georg T, Schwarz P, Marx N, Lindinger A: Reference values of NT-proBNP serum concentrations in the umbilical cord blood and in healthy neonates and children. Z Kardiol 2005;94:399–404.
19.
Yoshibayashi M, Kamiya T, Saito Y, Nakao K, Nishioka K, Temma S, Itoh H, Shirakami G, Matsuo H: Plasma brain natriuretic peptide concentrations in healthy children from birth to adolescence: marked and rapid increase after birth. Eur J Endocrinol 1995;133:207–209.
20.
Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S; International Diabetes Federation Task Force on Epidemiology and Prevention of Diabetes: the metabolic syndrome in children and adolescents. Lancet 2007;369:2059–2061.
21.
Mehra MR, Uber PA, Park MH, Scott RL, Ventura HO, Harris BC, Frohlich ED: Obesity and suppressed B-type natriuretic peptide levels in heart failure. J Am Coll Cardiol 2004;43:1590–1595.
22.
Das SR, Drazner MH, Dries DL, Vega GL, Stanek HG, Abdullah SM, Canham RM, Chung AK, Leonard D, Wians FH Jr, de Lemos JA: Impact of body mass and body composition on circulating levels of natriuretic peptides: results from the Dallas Heart Study. Circulation 2005;112:2163–2168.
23.
Rivera M, Cortés R, Salvador A, Bertomeu V, de Burgos FG, Payá R, Portolés M, Taléns-Visconti R, Martinez-Dolz L, Valero R, Sevilla B, Climent V: Obese subjects with heart failure have lower N-terminal pro-brain natriuretic peptide plasma levels irrespective of aetiology. Eur J Heart Fail 2005;7:1168–1170.
24.
Bayes-Genis A, Lloyd-Jones DM, van Kimmenade RR, Lainchbury JG, Richards AM, Ordoñez-Llanos J, Santaló M, Pinto YM, Januzzi JL Jr: Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea. Arch Intern Med 2007;167:400–407.
25.
Cortés R, Otero MR, Morillas P, Roselló-Lletí E, Grigorian L, Martínez-Dolz L, de Burgos FG, Calabuig JR, Soria F, Lozano T, Portolés M, Bertomeu V: Obese and nonobese patients with essential hypertension show similar N-terminal proBNP plasma levels. Am J Hypertens 2008;21:820–825.
26.
Sengenes C, Berlan M, De Glisezinski I, Lafontan M, Galitzky J: Natriuretic peptides: a new lipolytic pathway in human adipocytes. FASEB J 2000;14:1345–1351.
27.
Sarzani R, Paci VM, Zingaretti CM, Pierleoni C, Cinti S, Cola G, Rappelli A, Dessì-Fulgheri P: Fasting inhibits natriuretic peptides clearance receptor expression in rat adipose tissue. J Hypertens 1995;13:1241–1246.
28.
Dessì-Fulgheri P, Sarzani R, Rappelli A: The natriuretic peptide system in obesity-related hypertension: new pathophysiological aspects. J Nephrol 1998;11:296–299.
29.
Bayes-Genis A, DeFilippi C, Januzzi JL Jr: Understanding amino-terminal pro-B-type natriuretic peptide in obesity. Am J Cardiol 2008;101:89–94.
30.
Chang AY, Abdullah SM, Jain T, Stanek HG, Das SR, McGuire DK, Auchus RJ, de Lemos JA: Associations among androgens, estrogens, and natriuretic peptides in young women: observations from the Dallas Heart Study. J Am Coll Cardiol 2007;49:109–116.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.