Background: The N-terminal prohormone B-type natriuretic peptide (NT-proBNP) is a reliable marker of cardiac strain. In hypertensive heart disease, NT-proBNP levels increase and may lose its protective function. Simultaneously, the vasculature is also subject to hemodynamic stress, resulting in vascular matrix remodelling and stiffening which contribute to further cardiac alterations. Alkaline phosphatase (ALP) is a marker of osteoblast activity and is involved in vascular calcification. We explored the link between NT-proBNP and ALP in African and Caucasian men.

Design and measurements: This study included 128 African (mean age, 41.1 years) and 118 Caucasian (mean age, 36.4 years) men. Conventional measurements were acquired along with serum NT-proBNP and ALP.

Results: NT-proBNP correlated positively with ALP (r=0.29; p<0.001) in Africans, but inversely in Caucasians (r=–0.20; p=0.024). After minimal adjustment (age, body mass index, SBP and arterial compliance), the positive significant correlation of NT-proBNP with ALP remained in African men (r=0.225; p=0.014), whereas significance was lost in Caucasian men. Multiple regression analyses confirmed the independent association of NT-proBNP with ALP in African men (R²=0.37; β=0.248; p=0.005), as well as in younger African men (R²=0.26; β=0.375; p<0.001; n=96), with no significance in Caucasians.

Conclusions: NT-proBNP is independently and positively associated with ALP in African men. This was however not evident in Caucasian men. These results suggest that African men are susceptible to early vascular calcification and may develop cardiac afterload prematurely.