NT-proBNP (and BNP)

•RCT evidence— STOP-HF showed BNP-guided screening prevents HF

What it is

Both BNP and NT-proBNP come from the same precursor (proBNP), which is cleaved 1:1 into active BNP and inactive NT-proBNP when ventricular wall stress increases. Either is acceptable clinically. NT-proBNP has a longer half-life and is more stable for sampling, but both work.

Why it matters

• Rule-out test: low values essentially exclude heart failure in symptomatic patients.
• Prognostic: rising levels predict events long before symptoms.
• STOP-HF trial: BNP-guided primary-care screening + intervention prevented heart failure incidence in at-risk adults.

Modifiers to remember

• Age: rises 2–3× from middle to old age.
• Obesity: falsely lowers values.
• Renal impairment: falsely raises values.
• Atrial fibrillation: raises values.
• Sacubitril/valsartan: BNP rises (drug effect); NT-proBNP falls (drug effect) — use NT-proBNP for monitoring on sacubitril.

When to consider

• Dyspnoea evaluation (rules out heart failure).
• Adults >65 with cardiovascular risk factors as baseline screen.
• Pre-operative risk in cardiac surgery.
• Monitoring known heart failure response to therapy.

Related entries

Heart failure, Atrial fibrillation, hs-Troponin, SGLT2 inhibitors.