What is NT-proBNP?

NT-proBNP (N-terminal pro-brain B-type natriuretic peptide) is a signalling molecule produced by heart cells.1

Strained heart cells in patients with heart failure typically produce higher levels of NT-proBNP in the blood than heart cells in healthy individuals, making it an excellent biomarker for the disease.1–3

The data supporting the test are such that it is recommended by the ESC and NICE.3,4

How to interpret test results

If NT-proBNP levels are ≥400 ng/L, the patient should be referred to a cardiologist for assessment and diagnosis.4,5

Referral recommendations in the UK4,5

Special populations

For some special patient groups, it might not be appropriate to use the standard thresholds because other factors may be influencing their NT-proBNP level.2,6


Two of the most powerful confounders of NT-proBNP levels are renal function and obesity.2,6,7

Renal function2,6,7

  • Chronic or acute kidney disease can lead to elevated NT-proBNP levels
  • NT-proBNP thresholds may need to be raised when eGFR is <60 mL/min


  • People with a BMI ≥30 kg/m2 may have disproportionally lower NT-proBNP levels than those with a lower BMI
  • NT-proBNP thresholds should be lowered by about 50% in obese patients

Helpful information for the referral

If NT-proBNP levels are above the threshold for referral, ≥400 ng/L, the patient should be referred to a cardiologist for assessment and diagnosis.2–5

Consider including the following information in the referral8

Patient background
 Patient details Patient details
 ​Patient history ​Patient history
 Current medication(s) Current medication(s)
Vital signs
 Blood pressure Blood pressure
 Pulse Pulse
Relevant signs and symptoms, such as:
 Breathlessness Breathlessness
 Fatigue Fatigue
 Swollen ankles Swollen ankles
Investigation results if available
 NT-proBNP NT-proBNP
 Chest x-ray Chest x-ray
 ​Other blood test results (e.g. full blood count, albumin, urea and electrolytes, thyroid function) ​Other blood test results (e.g. full blood count, albumin, urea and electrolytes, thyroid function)

The patient profiles displayed in this material are hypothetical.

BMI, body mass index; ECG, electrocardiogram; eGFR, estimated glomerular filtration rate; ESC, European Society of Cardiology; NICE, National Institute for Health and Care Excellence; NT-proBNP, N-terminal pro-B-type natriuretic peptide; SIGN, Scottish Intercollegiate Guidelines Network.


1. Doust J, et al. Am Fam Physician. 2006;74:1893–1898. 2. Heindenreich PA et al. JACC. 2022;79:e263–e421. 3. McDonagh TA, et al. Eur Heart J. 2021;42:3599–3726. 4. National Institute for Health and Care Excellence (NICE). Chronic heart failure in adults: diagnosis and management. 2018. Available at: www.nice.org.uk/guidance/ng106 (accessed September 2023). 5. Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic heart failure. 2016. Available at: https://www.sign.ac.uk/assets/sign147.pdf (accessed September 2023). 6. Mueller C, et al. Eur J Heart Fail. 2019;21:715–731. 7. Charmetant X, et al. Clin Nephrol. 2019;92:65–72. 8. Data on file. REF-200932

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