Baseline plasma NT-proBNP and clinical characteristics: results from the irbesartan in heart failure with preserved ejection fraction trial

J Card Fail. 2010 Feb;16(2):128-34. doi: 10.1016/j.cardfail.2009.09.007. Epub 2009 Nov 4.


Background: N-terminal B type natriuretic peptide (NT-proBNP) is usually elevated in heart failure (HF) patients with reduced ejection fraction (EF). Less is known about NT-proBNP in HF with preserved EF (HF-PEF). We measured baseline NT-proBNP in 3562 HF-PEF enrolled patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial.

Methods and results: Patients with EF >or=45%, age >or=60 years, and either New York Heart Association (NYHA) II-IV symptoms with HF hospitalization (HFH) within 6 months or NYHA III-IV symptoms with corroborative evidence of HF or structural changes associated with HF-PEF. NT-proBNP (pg/mL) measured centrally using the Elecsys proBNP assay (Roche). Mean age 72 +/- 7 years, 60% were women, the investigator indicated HF etiology was hypertension in 64%; the majority were in NYHA III. Medications included diuretics in 82%, angiotensin-converting enzyme inhibitor in 26%, beta-blocker in 59%, and spironolactone in 15%. Median NT-proBNP was 341 pg/mL (interquartile range 135 to 974 pg/mL) and geometric mean was 354 pg/mL. In multivariate analysis, the baseline characteristics most strongly associated with higher NT-proBNP levels were atrial fibrillation (ratio of geometric mean 2.59, P < .001), NYHA IV symptoms (1.52, P < .001), lower estimated glomerular filtration rate (1.44, P < .001), and HFH hospitalization within 6 months (1.37, P < .001).

Conclusions: Most HF-PEF patients have elevated NT-proBNP levels. The NT-proBNP concentrations were related to baseline characteristics generally associated with worse outcomes for HF patients.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Biomarkers / blood
  • Biphenyl Compounds / therapeutic use*
  • Double-Blind Method
  • Female
  • Heart Failure / blood*
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Internationality
  • Irbesartan
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / biosynthesis
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / biosynthesis
  • Peptide Fragments / blood*
  • Protein Precursors / biosynthesis
  • Protein Precursors / blood*
  • Stroke Volume / drug effects
  • Stroke Volume / physiology*
  • Tetrazoles / therapeutic use*


  • Biomarkers
  • Biphenyl Compounds
  • Peptide Fragments
  • Protein Precursors
  • Tetrazoles
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Irbesartan