From the Guidelines
Brain natriuretic peptide (BNP) is monitored primarily to diagnose, assess severity, and guide treatment of heart failure, as it is a valuable biomarker for heart failure management, especially in ambulatory patients with dyspnea, as stated in the 2013 ACCF/AHA guideline 1. BNP levels rise when the heart is under strain, making it a useful indicator of cardiac stress.
Key Points to Consider
- Normal BNP levels are typically below 100 pg/mL, with levels above 400 pg/mL strongly suggesting heart failure.
- Regular BNP monitoring helps clinicians evaluate treatment effectiveness, adjust medications like diuretics, ACE inhibitors, or beta-blockers, and predict patient outcomes.
- BNP is particularly useful in emergency settings to differentiate between cardiac and non-cardiac causes of shortness of breath.
- The test is also valuable for monitoring patients with chronic heart failure, where rising levels may indicate worsening condition before clinical symptoms appear. Some studies suggest that serial monitoring of serum natriuretic peptide levels can result in a medium-term reduction in hospitalizations for heart failure, especially in patients younger than 75 years of age 1.
Clinical Application
- BNP monitoring should be considered in patients with heart failure to support clinical decision making regarding diagnosis, prognosis, and disease severity, as recommended by the 2013 ACCF/AHA guideline 1.
- Clinicians should consider specialist monitoring of serum natriuretic peptide levels in some patients, such as those with a history of hospitalization for exacerbations of heart failure or those in whom up-titration of pharmacologic therapy is problematic.
- The cost-effectiveness of serial serum natriuretic peptide monitoring has been demonstrated when used by specialists, making it a valuable tool in heart failure management 1.
From the Research
Importance of Monitoring Brain Natriuretic Peptide (BNP)
- BNP concentrations are useful in the diagnosis of heart failure, as well as having prognostic and therapeutic monitoring value 2
- A BNP level of 80 pg/mL is useful in diagnosing heart failure in symptomatic patients without a history of heart failure 2
- BNP levels are potentially more useful when a baseline concentration is known for a patient, because BNP levels are proportional to the severity of heart failure 2
Role of BNP in Heart Failure Management
- BNP testing may have a role in monitoring patients with heart failure, as treatment with certain medications reduces BNP levels 3
- Increases in BNP levels may be caused by intrinsic cardiac dysfunction or may be secondary to other causes such as pulmonary or renal diseases 3
- BNP level is a strong predictor of risk of death and cardiovascular events in patients previously diagnosed with heart failure or cardiac dysfunction 3
Guiding Therapy with BNP Levels
- Plasma brain natriuretic peptide (BNP) indicates the severity of left ventricular dysfunction, and hormone-guided therapy resulted in fewer clinical end points than did clinical management 4
- Testing for natriuretic peptide markers, such as B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP), has emerged as an important tool for the diagnosis and risk stratification of patients with HF 5
- Serial measurement of natriuretic peptides may guide management in heart failure (HF) patients, and home monitoring of BNP could reduce HF-related death and hospitalization 6
Predicting Clinical Deterioration
- The HOME HF study demonstrates the feasibility of home BNP measurement and shows the potential value of filtered BNP (fBNP) as an index of emerging clinical deterioration 6
- A moving average filter (fBNP) was calculated to reduce day-to-day fluctuations and track changes from week to week, and the hazard ratio for time-varying fBNP was 2.22 per unit natural log 6