Is a brain natriuretic peptide (BNP) level of 1214 nanograms per deciliter (ng/dL) considered elevated in an 85-year-old patient?

From the Guidelines

A BNP level of 1214 ng/dL is considered significantly elevated for an 85-year-old patient, indicating possible heart failure or other cardiac dysfunction. According to the European Society of Cardiology guidelines 1, normal serum natriuretic peptide levels are defined as BNP levels <100 ng/L or NT-proBNP levels <400 ng/L, and high serum natriuretic peptide levels are defined as BNP levels >400 ng/L or NT-proBNP levels >2000 ng/L. The patient's BNP level of 1214 ng/dL far exceeds these thresholds, suggesting a high likelihood of cardiac dysfunction.

Key Considerations

• The degree of elevation (over 1200 ng/dL) indicates a need for prompt medical evaluation, as it strongly correlates with cardiac dysfunction and warrants immediate attention, especially given the patient's advanced age which increases vulnerability to heart failure complications 1.
• The patient should be assessed for symptoms like shortness of breath, fatigue, edema, and chest discomfort.
• Further cardiac workup including echocardiogram, chest X-ray, and comprehensive metabolic panel would be appropriate to determine the underlying cause of the elevated BNP level.
• Treatment depends on the underlying cause but may include diuretics, ACE inhibitors, beta-blockers, or other heart failure medications.

Relevant Guidelines

• The National Institute for Health and Clinical Excellence recommends measurement of serum natriuretic peptide levels for diagnosis of heart failure, with elevated levels defined as BNP levels between 100 ng/L and 400 ng/L or NT-proBNP levels between 400 ng/L and 2000 ng/L 1.
• The European Society of Cardiology guidelines recommend measuring plasma NP levels (BNP, NT-proBNP, or MR-proANP) in all patients with acute dyspnea and suspected acute heart failure to help differentiate acute heart failure from non-cardiac causes of acute dyspnea 1.

From the Research

BNP Levels in Elderly Patients

• BNP levels are used to diagnose and monitor heart failure in patients, including the elderly 2, 3.
• A BNP level of 80 pg/mL is useful in diagnosing heart failure in symptomatic patients without a history of heart failure 2.
• However, BNP levels are not specific for any disease state, especially in patients with a history of heart failure or left ventricular dysfunction 2.
• In patients younger than 75 years, a BNP level less than 100 pg/mL is considered normal 3.
• For patients older than 75 years, the normal range for BNP is not explicitly stated in the provided studies, but it is known that BNP levels increase with age 4.

Elevated BNP Levels

• Extremely elevated BNP levels (>1694 pg/mL) are associated with older age, lower body mass index, higher blood urea nitrogen, higher creatinine, lower cardiac output, and lower cardiac index 4.
• A BNP level of 1214 ng/dL is significantly elevated, considering that normal levels are typically less than 100 pg/mL for patients younger than 75 years 3.
• Elevated BNP levels are a strong predictor of risk of death and cardiovascular events in patients previously diagnosed with heart failure or cardiac dysfunction 3, 4.

BNP Levels in Heart Failure Management

• BNP levels can be used to monitor patients with heart failure and guide medical therapy 5, 2, 3.
• A goal to maintain a BNP concentration of less than 100 pg/mL has been shown to correlate with functional improvement in patients with heart failure and tends to decrease clinical endpoints, such as cardiovascular death 2.
• ACE inhibitors, such as quinapril, can reduce BNP levels and improve functional capacity in elderly patients with heart failure 6.