N-terminal prohormone of brain natriuretic peptide

Blood levels

There is no level of BNP that perfectly separates patients with and without heart failure.

In screening for congenital heart disease in pediatric patients, an NT-proBNP cut-off value of 91 pg/mL could differentiate an acyanotic heart disease (ACNHD) patient from a healthy patient with a sensitivity of 84% and specificity of 42%. In patients with non-severe asymptomatic aortic valve stenosis, increased age- and sex adjusted NT-proBNP levels alone and combined with a 50% or greater increase from baseline had been found associated with increased event rates of aortic valve stenosis related events (cardiovascular death, hospitalization with heart failure due to progression of aortic valve stenosis, or aortic valve replacement surgery). In severe aortic valve stenosis, NT-proBNP provide important prognostic information beyond clinical and echocardiographic evaluation. Recent studies have found associations between long-term excessive variation in blood pressure and elevations in NT-proBNP levels.

Test usage in a clinical setting

Canada

While discussed in Canadian medical journals in the mid to late 2000s, the test is not widely used. It was only approved for use in Alberta in February 2012.

Test usage in the life insurance industry

The test has been widely used in the life insurance industry to screen applicants as part of the routine requirements when applying for a life insurance policy. It is also inexpensive and can be measured from blood samples routinely drawn as part of the application process. The test can be used to evaluate for a number of health conditions.

References

References

1. McKie, Paul M.. (2016-12-06). "NT-proBNP". Journal of the American College of Cardiology.
2. Hall, Christian. (2004). "Essential biochemistry and physiology of (NT-pro)BNP". European Journal of Heart Failure.
3. "UpToDate".
4. (2004). "B-type natriuretic peptide: the level and the drug--partners in the diagnosis of congestive heart failure". Congestive Heart Failure.
5. (September 2004). "A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction". American Heart Journal.
6. (May 2002). "Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy". Journal of the American College of Cardiology.
7. (October 2000). "Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina". Heart.
8. (November 2006). "Incremental prognostic value of C-reactive protein and N-terminal proB-type natriuretic peptide in acute coronary syndrome". Circulation Journal.
9. (January 2014). "NT-ProBNP independently predicts long-term mortality in patients admitted for coronary angiography". Angiology.
10. (April 2022). "Association of Annual N-Terminal Pro-Brain Natriuretic Peptide Measurements With Clinical Events in Patients With Asymptomatic Nonsevere Aortic Stenosis: A Post Hoc Substudy of the SEAS Trial". JAMA Cardiology.
11. (28 May 2020). "N-terminal-pro-BNP". The University of Iowa (UIHC), Department of Pathology.
12. Lee MA. (2009). "Basic Skills in Interpreting Laboratory Data". Amer Soc of Health System.
13. (July 2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". The New England Journal of Medicine.
14. (2011). "Usefulness of N-Terminal-Pro-B-Type Natriuretic Peptide as a Screening Tool for Identifying Pediatric Patients With Congenital Heart Disease". Laboratory Medicine.
15. (April 2022). "Association of Annual N-Terminal Pro-Brain Natriuretic Peptide Measurements With Clinical Events in Patients With Asymptomatic Nonsevere Aortic Stenosis: A Post Hoc Substudy of the SEAS Trial". JAMA Cardiology.
16. (2004-05-18). "Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis". Circulation.
17. (2014). "The Value of N-Terminal Pro–B-Type Natriuretic Peptide in Determining Antihypertensive Benefit: Observations From the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)". Hypertension.
18. (2025). "Blood pressure variability is associated with heart failure risk, elevated NT-proBNP, and elevated high-sensitivity troponin: the Multi-Ethnic Study of Atherosclerosis (MESA)". American Journal of Hypertension.
19. (July 2006). "Potential impact of N-terminal pro-BNP testing on the emergency department evaluation of acute dyspnea". CJEM.
20. "B-type Natriuretic Peptide (BNP) & NT-proBNP Test Implementation". Alberta Health Services.
21. (2010). "NT-proBNP The Finest Cardiovascular Screening and Reflexive Test In the History of Life Underwriting". Insureintell.
22. (2014). "NT-proBNP as a predictor of all-cause mortality in a population of insurance applicants". Journal of Insurance Medicine.