What causes elevated B-type natriuretic peptide (BNP)?

From the Guidelines

Elevated BNP levels are primarily caused by heart failure, where the heart cannot pump blood effectively, as well as other cardiac and non-cardiac conditions such as acute coronary syndromes, pulmonary embolism, myocarditis, left ventricular hypertrophy, and severe infections. The most recent and highest quality study, 1, provides a comprehensive list of causes of elevated BNP levels, including both cardiac and non-cardiac conditions. Some of the key cardiac causes of elevated BNP levels include:

• Heart failure
• Acute coronary syndromes
• Pulmonary embolism
• Myocarditis
• Left ventricular hypertrophy
• Hypertrophic or restrictive cardiomyopathy
• Valvular heart disease
• Congenital heart disease
• Atrial and ventricular tachyarrhythmias Non-cardiac causes of elevated BNP levels include:
• Advanced age
• Ischaemic stroke
• Subarachnoid haemorrhage
• Renal dysfunction
• Liver dysfunction (mainly liver cirrhosis with ascites)
• Paraneoplastic syndrome
• Chronic obstructive pulmonary disease
• Severe infections (including pneumonia and sepsis)
• Severe burns
• Anaemia
• Severe metabolic and hormone abnormalities It is essential to note that BNP levels can be influenced by various factors, including age, sex, weight, and renal function, and should be interpreted cautiously in certain individuals, such as women and people over 60 years of age who do not have heart failure, as mentioned in 1. In clinical settings, BNP testing helps diagnose heart failure, with levels above 100 pg/mL suggesting possible heart failure and levels exceeding 400 pg/mL strongly indicating heart failure, as stated in 1. Treatment focuses on addressing the underlying cause, typically with medications like diuretics, ACE inhibitors, beta-blockers, and lifestyle modifications to reduce cardiac strain. Overall, elevated BNP levels can be caused by a range of cardiac and non-cardiac conditions, and accurate diagnosis and treatment require careful consideration of the underlying cause and individual patient factors.

From the Research

Causes of Elevated B-type Natriuretic Peptide (BNP)

Elevated BNP levels can be caused by various factors, including:

• Increased ventricular wall stress, which is a major force driving left ventricular remodeling 2, 3
• Cardiac disease states such as:
  • Congestive heart failure (CHF) 2, 4
  • Acute coronary syndromes 2
  • Diastolic dysfunction 2, 4
  • Atrial fibrillation (AF) 2
  • Amyloidosis 2
  • Restrictive cardiomyopathy (RCM) 2
  • Valvular heart disease 2
• Non-cardiac diseases such as:
  • Pulmonary hypertension 2, 5
  • Chronic obstructive pulmonary disease (COPD) 2
  • Pulmonary embolism 2, 5
  • Renal failure 2
• Critical illness such as:
  • Acute decompensated CHF (ADHF) 2
  • Sepsis 2
• Myocardial ischemia, particularly in patients with a history of myocardial infarction 6

Factors Influencing BNP Levels

BNP levels can be influenced by various factors, including:

• Age 2
• Gender 2
• Body mass index (BMI) 2
• Renal function, as BNP levels can be elevated in patients with renal failure 2
• Treatment with certain medications, such as angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, spironolactone, and diuretics, which can reduce BNP levels 4