Monitoring the plasma brain natriuretic peptide (BNP) level in individuals with pulmonary arterial hypertension (PAH) may aid clinicians in therapeutic decision-making and overall prediction of 5-year survival rates, according to an article published by Chest.
Researchers identified 1426 individuals from the multicenter, observational US-based Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) to determine the clinical relationship between BNP levels and overall survival rates in individuals with PAH. Individuals were placed into 4 groups based on their baseline and follow-up BNP values at 1 year, with low and high BNP thresholds set at ≤340 and >340 pg/mL, respectively: low-low, low-high, high-high, and high-low.
Study results found that individuals with a high baseline BNP (n=375) have a higher mortality risk compared with those with a low baseline value (n=1051; hazard ratio [HR], 3.6; 95% CI, 3.0-4.2, P <.001). Overall, the groups with the highest and lowest mortality risks at ≤1 year were found to be those individuals in the high-high and low-low groups (HR, 0.23; 95% CI, 0.19-0.27), with a lower 5-year risk for death in the low-low group compared with the high-high group (HR, 0.12; 95% CI, 0.13-0.19; P <.001). Five-year survival rates in individuals with a baseline BNP of ≤340 and >340 pg/mL were found to be 72.9% (95% CI, 70.0%-75.6%) and 32.5% (95% CI, 27.4%-37.8%), respectively.
Although BNP levels remained low in 62.9% of individuals with a low baseline BNP, levels continued to rise in 12.6% of patients until approximately 3 years. Individuals with high BNP had levels that decreased over time to a low level (9.1%); however, 15.4% of individuals with high levels at baseline remained at the same level at last assessment.
Within 1 year, individuals with high BNP at baseline whose levels decreased to a low BNP (n=75) experienced only 39 events and a reduced death risk of 40% (HR, 0.60; 95% CI, 0.43-0.85; P =.004). Individuals in the low-high group were found to have a higher risk for death compared with those in the low-low group at both 1 and 5 years (HR, 3.2 [95% CI, 2.35-4.46; P <.001] and HR, 3.9 [95% CI, 3.02-4.97; P <.001], respectively). In addition, individuals in the high-high group had a higher risk for death compared with those in the low-high group (HR, 0.72 [95% CI, 0.52-1.004; P =.05] and HR, 0.61 [95% CI, 0.48-0.78; P <.001], respectively). Five-year survival rates in individuals with a baseline BNP of ≤340 and >340 pg/mL were noted to be 72.9% (95% CI, 70.0%-75.6%) and 32.5% (95% CI, 27.4%-37.8%), respectively.
Researchers concluded that trending BNP levels in individuals with PAH is an inexpensive and useful method for strongly predicting their 5-year mortality risk at a predictive threshold level of 340 pg/mL. Therefore, clinicians should consider the use of this biomarker in aiding treatment decision making.
Frantz RP, Farber HW, Badesch DB, et al. Baseline and serial brain natriuretic peptide level predicts 5-year overall survival in patients with pulmonary arterial hypertension: data from the REVEAL registry [published online January 16, 2018]. Chest. doi:10.1016.j.chest.2018.01.009