Increased NT-ProBNP May Help Identify Patients at High Risk for CVD Across BP Categories

Blood pressure cuff
Blood pressure cuff
Elevated NT-proBNP may represent a useful biomarker for the identification of individuals at high risk for CVD and mortality across the spectrum of blood and pulse pressures.

Elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) may represent a useful biomarker for the identification of individuals at high risk for cardiovascular disease (CVD) and mortality across the spectrum of diastolic (DBP) and systolic blood pressures (SBP) and pulse pressure (PP), according to a study published in the Journal of the American College of Cardiology.

A total of 9309 participants (mean age, 62.6±5.6 years) from study who participated in the fourth visit (1996 to 1998) as part of the Atherosclerosis Risk In Communities study were included in this analysis. Participants were group according to SBP, DBP, and PP categories.

The SBP categories were the following: <120 mmHg, 120 to 129 mmHg, 130 to 139 mmHg, 140 to 149 mmHg, and ≥150 mmHg. The DBP categories were: <60 mmHg, 60 to 69 mmHg, 70 to 79 mmHg, 80 to 89 mmHg, and ≥90 mm Hg. PP categories were: <40 mmHg, 40 to 49 mmHg, 50 to 59 mmHg, 60 to 69 mmHg, and ≥70 mm Hg. Patients were further categorized into NT-proBNP categories: <100 pg/mL (n=6361), 100 to <300 pg/mL (n=2470), and ≥300 pg/mL (n=478).

Risk for incident CVD (ie, coronary heart disease, ischemic stroke, or hospitalization for heart failure) and mortality were assessed across combined NT-proBNP and/or BP categories using Cox regression models. Analyses were adjusted for CVD risk factors.

Over a median follow-up of 16.7 years, there were 2416 CVD events in this cohort, including 1359 incidents of congestive heart disease (10.2 per 1000 person-years), 500 incidents of ischemic stroke (3.6 per 1000 person-years), and 1328 incidents of heart failure hospitalizations (9.7 per 1000 person-years).

NT-proBNP levels between 100 and <300 pg/mL vs <100 pg/mL were associated with a graded increase in the risk for CVD events and mortality for each SBP, DBP, or PP category. Patients with SBP between 130 and 139 mmHg and NT-proBNP ≥300 pg/Ml compared with those in the same SBP category and NT-proBNP <100 pg/mL was 3.4 for CVD (95% CI, 2.44-4.77).

Study limitations include its observational nature, which may prevent the ability to draw causal conclusions.

 “Future trials should consider validation of a biomarker-assisted approach to guide risk-based decisions for BP treatment initiation or titration,” concluded the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Hussain A, Sun W, Deswal A, et al. Association of NT-proBNP, blood pressure, and cardiovascular events: The ARIC study. J Am Coll Cardiol. 2021;77(5):559-571. doi:10.1016/j.jacc.2020.11.063