American Journal of Hypertension · Oct 24, 2026
The mediating role of sleep blood pressure in the association between B-type natriuretic peptide and cardiovascular events: The Nagahama Study
By Tabara Y, Murase K, Matsumoto T et al.
BACKGROUND: B-type natriuretic peptide (BNP) is a risk marker for not only heart failure but also cardiovascular diseases (CVD). This study investigated the possible mediating role of sleep blood pressure (BP) in the association between BNP and CVD events. METHODS: Data for 5,751 participants were obtained from the Nagahama Study, a longitudinal cohort study of the general Japanese population. Circulating BNP levels were determined from blood specimens. BP was measured at home in the morning and evening, and three times per night during sleep using a timer-equipped cuff-oscillometric device. RESULTS: During the mean follow-up period of 9.4 years (54,350 person-years), 169 CVD cases were observed (Incidence rate: 31.1 per 10,000 person-year, 95% confidence interval [CI]: 26.7, 36.2). BNP levels ≥40 pg/mL were independently associated with CVD. The sleep BP-adjusted hazard ratio of high BNP for CVD was 1.80 (95% CI: 1.18, 2.74), while the awake home BP-adjusted hazard ratio was 1.92 (95% CI: 1.26, 2.91). Causal mediation analysis indicated a greater mediation rate of sleep SBP (14.3%, 95% CI: -2.8, 31.3) than awake home SBP (5.8%, 95% CI; -2.6, 14.2) in the association between BNP and CVD incidence. Factors associated with log-normalized BNP levels were age, sex, body mass index, sleep SBP, and nocturnal urination frequency. CONCLUSION: Prognostic significance of BNP for CVD events was partially mediated by BP particularly BP during sleep.