Plasma atrial and brain natriuretic peptide concentrations in a case of malignant hypertension

We examined the alternation of the plasma atrial and brain natriuretic peptide (ANP and BNP) concentrations during clinical course of a 57-year-old male with malignant hypertension. The patient exhibited marked elevation of diastolic blood pressure up to 152 mmHg with progressive organ damages snch as concentric cardiac hypertrophy, hypertensive retinopathy, and renal insufficiency. In the present case, extreme hypertension and markedly activated renin-angiotensin system (the plasma renin activity, 35.3 ng/ml/h; the plasma aldosterone concentration, 321.4 pg/ml) caused cardiac overload and hypertrophy (the left ventricular mass index, 161 g/m²) which was considered to lead to marked increase of the plasma BNP concentration (1195.5 pg/ml), much higher than the concomitantly elevated plasma ANP concentration (197.1 pg/ml). During the clinical course, the blood pressure decreased trom 268/152 mmHg to 148/82 mmHg, and the left ventricular mass index decreased from 161 g/m² to 136 g/m², in response to the anti-hypertensive therapy with Ca-entry blockers and angiotensin converting enzyme inhibitors. Following the decrease of blood pressure and regression of cardiac hypertrophy, the elevated plasma BNP concentration significantly decreased to 47.7 pg/ml, lower than the concomitantly decreased plasma ANP concentration (68.8 pg/ml). The present report indicates the usefulness of the plasma BNP concentration as a marker to determine the severity of cardiac overload and hypertrophy during the clinical course of hypertensive patients.