Association of NT-ProBNP, Blood Pressure, and Cardiovascular Events: The ARIC Study

Aliza Hussain, Wensheng Sun, Anita Deswal, James A. de Lemos, John W. McEvoy, Ron C. Hoogeveen, Kunihiro Matsushita, David Aguilar, Biykem Bozkurt, Salim S. Virani, Amil M. Shah, Elizabeth Selvin, Chiadi Ndumule, Christie M. Ballantyne, Vijay Nambi

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background: Although intensive blood pressure reduction has cardiovascular benefits, the absolute benefit is greater in those at higher cardiovascular disease (CVD) risk. Objectives: This study examined whether N-terminal pro–B-type natriuretic peptide (NT-proBNP) helps identify subjects at higher risk for CVD events across systolic blood pressure (SBP), diastolic blood pressure (DBP), or pulse pressure (PP) categories. Methods: Participants from the ARIC (Atherosclerosis Risk In Communities) study visit 4 (1996 to 98) were grouped according to SBP, DBP, or PP categories and further stratified by NT-proBNP categories. Cox regression models were used to estimate hazard ratios for incident CVD (coronary heart disease, ischemic stroke, or heart failure hospitalization) and mortality across combined NT-proBNP and/or BP categories, adjusting for CVD risk factors. Results: There were 9,309 participants (age: 62.6 ± 5.6 years; 58.3% women) with 2,416 CVD events over a median follow-up of 16.7 years. Within each SBP, DBP, or PP category, a higher category of NT-proBNP (100 to <300 or 300 pg/ml, compared with NT-proBNP <100 pg/ml) was associated with a graded increased risk for CVD events and mortality. Participants with SBP 130 to 139 mm Hg but NT-proBNP ≥300 pg/ml had a hazards ratio of 3.4 for CVD (95% confidence interval: 2.44 to 4.77) compared with a NT-proBNP of <100 pg/ml and SBP of 140 to 149 mm Hg. Conclusions: Elevated NT-proBNP is independently associated with CVD and mortality across SBP, DBP, and PP categories and helps identify subjects at the highest risk. Participants with stage 1 hypertension but elevated NT-proBNP had greater cardiovascular risk compared with those with stage 2 SBP but lower NT-proBNP. Future studies are needed to evaluate use of biomarker-based strategies for CVD risk assessment to assist with initiation or intensification of BP treatment.

Original languageEnglish
Pages (from-to)559-571
Number of pages13
JournalJournal of the American College of Cardiology
Issue number5
StatePublished - Feb 9 2021

Bibliographical note

Publisher Copyright:
© 2021


  • NT-proBNP
  • blood pressure
  • cardiac biomarkers
  • cardiovascular disease
  • cardiovascular risk assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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