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

## TL;DR

The study finds that white individuals may have a higher increase in natriuretic peptide levels than Black individuals after exercise.

## Contribution

This is the first study to compare NP responses to physiological stressors like exercise and metoprolol in healthy Black and white individuals.

## Key findings

- Exercise increased MR-proANP, NT-proBNP, and BNP in both races, but NT-proBNP increases were higher in white individuals.
- Metoprolol increased all NP biomarkers similarly in both races.
- Race-based differences were observed only in NT-proBNP response to exercise.

## 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.

Although Black individuals have been shown to have lower natriuretic peptide concentrations compared to white individuals, the differences in the NP response to physiological perturbations in these two groups are unknown. Here, the authors conduct a physiological clinical trial among young, healthy, normotensive adults to show that white individuals may have a higher increase in NP concentrations compared to Black participants in response to physiological perturbations such as exercise.