Prediction of heart failure by amino terminal-pro-B-type natriuretic peptide and C-reactive protein in subjects with cerebrovascular disease

Hypertension. 2005 Jan;45(1):69-74. doi: 10.1161/01.HYP.0000151103.02424.c3. Epub 2004 Nov 29.


B-type natriuretic peptide (BNP) and C-reactive protein (CRP) are elevated in persons at risk for congestive heart failure (CHF). However, limited data are available directly comparing BNP-related peptides and CRP in persons at risk of CHF. To evaluate amino terminal-pro-BNP (NT-proBNP) and CRP, separately and together, for assessment of risk of CHF, we performed a nested case-control study of the 6105 participants of the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), a placebo-controlled study of a perindopril-based blood pressure-lowering regimen among individuals with previous stroke or transient ischemic attack (TIA). Each of 258 subjects who developed CHF resulting in death, hospitalization, or withdrawal of randomized therapy during a mean follow-up of 3.9 years was matched to 1 to 3 control subjects. NT-proBNP and CRP predicted CHF; the odds ratio for subjects in the highest compared with the lowest quarter was 4.5 (95% confidence interval, 2.7 to 7.5) for NT-proBNP and 2.9 (confidence interval, 1.9 to 4.7) for CRP, and each remained a predictor of CHF after adjustment for all other predictors. Screening for both markers provided better prognostic information than screening for either alone. Elevation of NT-proBNP above 50 pmol/L and CRP above 0.84 mg/L predicted CHF with sensitivity of 64% and specificity of 66%. NT-proBNP and CRP predicted CHF in subjects receiving perindopril-based therapy. We conclude that NT-proBNP and CRP are independent predictors of CHF risk after stroke or TIA. Moreover, NT-proBNP and CRP may be markers of mechanisms of CHF pathogenesis distinct from those responsive to angiotensin-converting enzyme inhibitor-based therapy.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Biomarkers
  • C-Reactive Protein / analysis*
  • Case-Control Studies
  • Cerebrovascular Disorders / blood*
  • Cerebrovascular Disorders / epidemiology
  • Female
  • Follow-Up Studies
  • Heart Failure / blood
  • Heart Failure / epidemiology*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Incidence
  • Ischemic Attack, Transient / blood
  • Ischemic Attack, Transient / epidemiology
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain
  • Nerve Tissue Proteins / blood*
  • Peptide Fragments / blood*
  • Perindopril / therapeutic use
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Sensitivity and Specificity
  • Stroke / blood
  • Stroke / epidemiology


  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Biomarkers
  • Nerve Tissue Proteins
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • C-Reactive Protein
  • Perindopril