N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) in Stage 1 and Stage 2 Hypertension Patients

Received: July 10, 2019 Revised: July 30, 2019 Accepted: October 7, 2019 Abstract The increased levels of NT-proBNP in the blood occur when heart function, especially the left ventricular muscle chambers of the heart increases. Therefore, NT-proBNP is used as a biomarker to detect heart failure.The level of N Terminal – Pro Brain Natriuetic Peptide was independently associated with an increased risk of hypertension. This study aimed to determine the difference of NT-proBNP serum levels and the correlation between the levels of NT-proBNP in patients with stage 1 and stage 2 hypertension. This research was conducted at RSUP dr. Wahidin Sudirohusodo in August September 2018. The study used a crosssectional design with the total of 72 hypertensive patients, who had met the inclusive criteria. NT-proBNP levels were measured using the ELISA (Enzyme Linked Immunosorbent Assay) method. The collected data was processed using Mann Whitney Different Test and Spearman's rho Correlation Test. The study results indicated that the level of NT-proBNP in the hypertensive patients with stage 2 was higher and significantly different (p = <0.001) compared to stage 1 hypertensive patients. NTproBNP levels were higher in the hypertensive group of >6 years than in the hypertensive group <6 years. There were significant differences between the two groups statistically (p=0.010). It can be Conclude that there is a significant difference in the levels of NT-proBNP with a degree of hypertension where NT-proBNP levels were higher in patients with stage 2 hypertension compared to stage 1 hypertension, although there was not statistically significant correlation between levels of NT-proBNP with Hypertension degree. Further research was needed to determine the relationship of NT-proBNP levels with the degree of hypertension, which can confirm the diagnosis, especially in patients with hypertension. Also, it is suggested to consider the accuracy of the data length of a patient suffering from undiagnosed hypertension.


INTRODUCTION
Hypertension or high blood pressure is a global health problem, including in Indonesia because of the high prevalence, although different in various state. Hypertension does not give complaints and typical symptoms so many people do not realize it since it was dubbed as the silent killer (1). Hypertension is defined as someone who had a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, on repeated examinations (2). Hypertension is one of the most common diseases found in primary medical practice which is also a risk factor of myocardial infarction, stroke, acute kidney failure, and death (3).
According to NHLBI (National Heart, Lung, and Blood Institute), 1 in 3 (patients) suffers from hypertension. In a metaanalysis study that included 61 prospective international studies in 1 million patients, which was equivalent to 12.7 million personyears, it was found that a decrease in mean systolic blood pressure of 2 mmHg could reduce the risk of mortality from ischemic heart disease by 7% and reduce the risk of stroke mortality by 10%. Achieving the target of reducing blood pressure is very important to reduce cardiovascular events in hypertensive patients (4).

The Health Profile of South Sulawesi
Province in 2016 showed the prevalence of hypertension in South Sulawesi Province obtained through population blood pressure measurements at the age of > 18 years with a total of 142,571 cases (5

Levels of NT-proBNP Analysis Based Research Subject Characteristics
The results of statistical analysis of the study subjects showed significant differences in the levels of NT-proBNP based on old patient suffering from hypertension (p=0.010) and degree of hypertension (p=<0.001).
The results of statistical analysis in Table   2

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The results of statistical analysis in Table   3 is based on the characteristics of the study subjects which showed no correlation with the levels of NT-proBNP after Spearman's rho test (p<0.05) so that it can be concluded that there was no relationship between the levels of NT-proBNP with the degree of hypertension.

DISCUSSION
This research shows that there were more patients with hypetension in women than men and those whose age> 45 years old than those whose age <45 years old. Age is an importan factor of hypertension. When someone get older, the risk of hypertension is also higher.
An increase in hypertension cases will develop in their fifties and sixties. Increase in blood pressure with the increase in age is a normal condition. However, if the change of blood pressure is too striking and accompanied by other factors, it triggers hypertension with its complications (11).
According to Azhar (12), it was stated that hypertension is more common in women than in men, this happens because premenopausal women are protected by the hormone estrogen which can increase the concentration of HDL and decrease LDL concentrations. However, when women experience menopause, estrogen will decrease. Mainly experienced by women who are elderly, so that the blood pressure in elderly women tend to be high (12).
As a biochemical marker that gives new hope to the cardiovascular field, the normal value of NT-proBNP still cannot be fully

CONFLICT OF INTEREST
There are no conflicts of interest.