Natriuretic Peptide Levels and Race

Study Questions:

What is the impact of race/ethnicity on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels?


The investigators examined plasma NT-proBNP levels according to race/ethnicity in 3,148 individuals (51% black, 31% white, 18% Hispanic) free of prevalent cardiovascular disease in the Dallas Heart Study. NT-proBNP values in the bottom sex-specific quartile were defined as low. Multivariable linear and logistic regression analyses were performed, adjusting for clinical covariates and magnetic resonance imaging measurements of cardiac structure and function.


Hypertension was present in 41%, 25%, and 16% of black, white, and Hispanic individuals, respectively. Unadjusted NT-proBNP levels were lowest in black (median: 24 pg/ml; interquartile range [IQR], 10-52 pg/ml) as compared with Hispanic (30 pg/ml; IQR, 14-59 pg/ml) and white individuals (32 pg/ml; IQR, 16-62 pg/ml), p < 0.0001. In multivariable-adjusted models, black individuals still had significantly lower NT-proBNP levels (-39% [95% confidence interval, -46% to -31%]; p < 0.0001) and greater odds of having low NT-proBNP (odds ratio, 2.46 [95% confidence interval, 1.86-3.26]), compared with white individuals. In contrast, NT-proBNP levels did not significantly differ between Hispanic and white individuals (p = 0.28). The finding of lower NT-proBNP levels in black individuals was similar when analyses were restricted to healthy participants without cardiovascular risk factors.


The authors concluded that NT-proBNP levels differ substantially according to race/ethnicity.


This population-based, multiethnic study reports that black individuals have considerably lower plasma natriuretic peptide levels than white individuals. These findings support the hypothesis that black race is associated with a ‘relative deficiency’ in natriuretic peptides and raises the possibility that a blunted natriuretic peptide system might contribute to the increased susceptibility to hypertension and related disorders in blacks. The natriuretic peptide system may represent a target for the prevention and treatment of cardiovascular disease, particularly in black individuals, and merits further study.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Magnetic Resonance Imaging, Hypertension

Keywords: African Americans, Biological Markers, Heart Failure, Hispanic Americans, Hypertension, Magnetic Resonance Imaging, Natriuretic Peptide, Brain, Natriuretic Peptides, Peptide Fragments, Primary Prevention, Risk Factors

< Back to Listings