Differences in natriuretic peptide response in self-identified white and black individuals: a physiological clinical trial

Naman S. Shetty, Mokshad Gaonkar, Nirav Patel, Nehal Vekariya, Krishin Yerabolu, Jasninder S. Dhaliwal, Thomas W. Buford, Barbara Gower, Peng Li, Thomas J. Wang, Garima Arora and Pankaj Arora ()
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Naman S. Shetty: Massachusetts General Hospital
Mokshad Gaonkar: University of Alabama at Birmingham
Nirav Patel: University of Alabama at Birmingham
Nehal Vekariya: University of Alabama at Birmingham
Krishin Yerabolu: University of Alabama at Birmingham
Jasninder S. Dhaliwal: University of Alabama at Birmingham
Thomas W. Buford: University of Alabama at Birmingham
Barbara Gower: University of Alabama at Birmingham
Peng Li: University of Alabama at Birmingham
Thomas J. Wang: University of Texas-Southwestern Medical Center
Garima Arora: University of Alabama at Birmingham
Pankaj Arora: University of Alabama at Birmingham

Nature Communications, 2025, vol. 16, issue 1, 1-9

Abstract: Abstract Black individuals have lower plasma natriuretic peptide (NP) concentrations than white individuals. However, race-based differences in the NP response to physiological perturbations are unknown. In this physiological trial (NCT#03070184), we measured the NP [mid-regional atrial NP (MR-proANP), N-terminal pro-B-type NP (NT-proBNP), and BNP] response to physiological perturbations among healthy, self-identified Black and white participants aged 18-40 years. The primary and secondary outcomes were the change in plasma NP concentrations at 6 weeks after metoprolol (initiated at 50 mg/day and doubled every 2 weeks) and standardized, aerobic exercise (70% of their maximal oxygen uptake on a salt-standardized background), respectively. Among 40 Black [median age: 27 (22, 32) years; 21 (52.5%) women] and 40 white [median age: 25 (20, 30) years; 19 (47.5%) women] participants, exercise increased MR-proANP (Black: 35%; white: 43%), NT-proBNP (Black: 11%; white: 23%), and BNP (Black: 59%; white: 61%) in both self-reported races. Exercise was associated with an increase in plasma MR-proANP (pinteraction: 0.25) and BNP (pinteraction: 0.87) concentrations which did not vary by self-reported race. However, the increase in plasma NT-proBNP concentrations were higher in white participants than in Black participants. (pinteraction: 0.04) Similarly, metoprolol therapy increased MR-proANP (Black: 18%; white: 16%), NT-proBNP (Black: 95%; white: 99%), and BNP (Black: 45%; white: 74%) in both self-reported races. The metoprolol-associated increase in plasma MR-proANP (pinteraction: 0.85), NT-proBNP (pinteraction: 0.94), and BNP (pinteraction: 0.21) concentrations were similar by self-reported race. In conclusion, the higher increase in plasma NT-proBNP concentrationsamong white patients after exercise suggests that exercise may induce significant physiological variations in NP levels. ClinicalTrials.gov ID: NCT03070184.

Date: 2025
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DOI: 10.1038/s41467-024-55648-2

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