Natriuretic Peptides BNP and Nterminal proBNP

Blood levels of natriuretic peptides are used in the evaluation of heart failure. Cardiac cells release natriuretic peptides, in response to stretch and wall tension. Ventricular myocytes release a pro-B-type natriuretic peptide (pro-BNP), which is cleaved into the active B-type natriuretic peptide (BNP) and the inactive N-terminal pro-BNP (NT-pro-BNP). Levels of both BNP and NT-pro-BNP increase with age and in renal insufficiency and are reduced in women and obese patients. Some medications, including spironolactone, ACE inhibitors, and angiotensin receptor blockers, lower BNP/NT-pro-BNP levels. Other conditions that increase natriuretic peptides include myocardial ischemia, atrial fibrillation, pulmonary embolus, pulmonary hypertension, chronic kidney disease, and sepsis.

The major established use of BNP testing is evaluating acute dyspnea, when the cause is uncertain, to differentiate whether the etiology is from heart failure versus another cause. A normal level in a patient with acute dyspnea has a high negative predictive value and suggests that heart failure is unlikely the etiology. Elevated levels of BNP and NT-pro-BNP also are predictive of death or increased cardiovascular events. The optimal cutoffs for BNP/NT-pro-BNP vary with age. BNP less than 100 pg/mL or NT-pro-BNP less than 400 pg/mL makes the diagnosis of heart failure unlikely. Levels of BNP greater than 400 pg/mL or NT-pro-BNP greater than 2000 suggest heart failure (Dickstein et al., 2008). Using BNP measures to guide therapy in patients with established heart failure did not improve overall survival, quality of life, or total hospitalization but did reduce hospitalizations for heart failure in patients less than 75 years old (Pfisterer et al., 2009).

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