Natriuretic peptides and cardiovascular variability

N owadays, the burden of cardiovascular disease represents a major global public health issue, both for its economic and social consequences. Along with improvedprevention and treatment strategies, a prompt diagnosis is therefore a mainstay in cardiovascular patients’ management. Following a paradigm shift which occurred over the last decades, the diagnostic approach to cardiovascular problems is no longer limited to identification of a disease in patients with clinical symptoms, but rather it currently involves early detection of individuals with elevated risk of developing cardiovascular alterations (due to the presence of risk factors or preclinical organ damage), in whom targeted interventions aimed at interfering with the progression along the ‘cardiovascular continuum’ may significantly change the natural history of the disease. Many indicators of increased cardiovascular risk have been identified over the years. Along with the classic cardiovascular risk factors such as elevated blood pressure (BP), low-density lipoprotein cholesterol, diabetes, renal dysfunction, etc., other, less commonly used parameters, including brain natriuretic peptide (BNP) and BP variability (BPV), have been demonstrated to be independently associated with cardiovascular outcomes [1]. BNP is a hormone secreted by cardiomyocytes under conditions characterized by various types of cardiac overload [2] and its secretion reflects hemodynamic alterations and left ventricular dysfunction. As a hallmark of heart failure, BNP has become an essential element in diagnosis, management and prognostic stratification of heart failure patients. More recently, however, it was shown that elevations of BNP (or of its precursor N-terminal proBNP) may also be associated with preclinical stages of cardiac disease: its level increases in the presence of left ventricular hypertrophy in patients with hypertension [3] and, even in the