BNP/NT-proBNP Risk Tier: Explanation and Clinical Context The BNP/NT-proBNP Risk Tier is a validated system to classify patients according to the circulating levels of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP). These biomarkers reflect myocardial wall stress, ventricular overload, and cardiac dysfunction in conditions such as pulmonary arterial hypertension (PAH) and heart failure.
Levels are stratified into low, intermediate, and high risk tiers based on established cutoffs. Low-risk values indicate near-normal cardiac stress and favorable prognosis, intermediate-risk values suggest mild to moderate ventricular strain requiring close monitoring, and high-risk values correlate with significant myocardial stress and increased short-term mortality.
In PAH, BNP >180 pg/mL or NT-proBNP >1100 pg/mL contributes to increased REVEAL 2.0 risk score and predicts higher 1-year mortality. Serial measurements are crucial for monitoring disease progression and guiding therapy escalation, including advanced PAH-specific treatments or heart failure management.
This risk tiering is used both in clinical practice and research to optimize risk stratification, evaluate treatment response, and support prognostic decision-making.
Reference:
Benza RL, et al. Development and Validation of the REVEAL 2.0 Risk Score for Pulmonary Arterial Hypertension. Chest. 2019;156(2):323–337.
Benza RL, et al. REVEAL Lite 2: Simplified Risk Assessment in PAH. Chest. 2021;160(2):575–586.
Galiè N, et al. 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Eur Heart J. 2022;43(38):3618–3731.
Januzzi JL Jr, et al. The Role of Natriuretic Peptides in Heart Failure. J Am Coll Cardiol. 2018;71(2):227–245.