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Ask an Underwriter: What is NT-proBNP and why does it matter?


NT-proBNP is a fairly new blood test, for both clinical medicine and insurance risk assessment. 


What is it? 

B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are hormones produced by your heart to regulate blood pressure and fluid balance. Normally, circulating BNP and NT-proBNP levels are quite low – they increase when pressure in your heart changes due to increased blood volume, fluid retention or ischemia. 


How is it Used?


Due to its predictive value in assessing the strain to the heart, NT-proBNP is considered by American College of Cardiology to be the benchmark against other biomarkers for heart failure.1  Results may help determine if you have heart failure versus other causes of dyspnea (difficulty breathing or shortness of breath). Increased levels in patients with difficulty breathing show an increase in likelihood of heart failure.


Elevated NT-proBNP can also be found in other conditions, including acute lung injury, acute myocardial infarct, atrial fibrillation, cardiac amyloidosis, COPD, chronic renal failure, cirrhosis, hypertension, pulmonary hypertension, pulmonary embolism with associated right ventricular dysfunction and subarachnoid hemorrhage.


Normal NT-proBNP levels (based on Cleveland Clinic’s Reference Range2):

  • Less than 125pg/mL for patient’s age 0-74 years
  • Less than 450 pg/nL for patient’s 75 and older


If you have heart failure, the following NT-proBNP levels could mean your heart function is unstable:

  • Higher than 450 pg/mL for patients under age 50
  • Higher than 900 pg/mL for patient 50 and over


ProBNP levels are higher in women, older individuals and people with renal insufficiency. Some medications, such as ACE inhibitors, beta-blockers, spironolactone and diuretics have been known to decrease levels.


What’s it mean for underwriting?

NT-proBNP has been selected over BNP as the superior test for insurance companies, as it is easier for parameds to correctly administer the blood draw. This simple blood test is run by carriers for certain ages and amounts, often in lieu of resting EKGs, and has helped eliminate the need for stress EKG testing at larger face amounts.


In their risk assessment, insurance carriers use NT-proBNP along with many other cardiac risk factors (hypertension, hyperlipidemia, family history of coronary artery disease in first-degree relative, tobacco use and diabetes) and any known history of vascular disease, atrial fibrillation, congestive heart failure and/or renal insufficiency. 


Elevated NT-proBNP levels could prompt an underwriter to ask for additional cardiac work-up, such as a repeat blood test, stress test, echocardiogram and/or cardiology consult.


Ash Brokerage is here to assist you! To simplify your fact-finding process, use our NT-proBNP Client Questionnaire and reach out to us for help. We leverage our experience, carrier relationships and resources to identify viable solutions based on your client’s individual circumstances and insurance needs.  


Learn More 

1Journal of the American College of Cardiology, “NT-proBNP: The Gold Standard Biomarker in Heart Failure,” December 2016:

 2Cleveland Clinic, B-type Natriuretic Peptide (BNP) Blood Test:


About the Author

Diane Fulk has been in the life insurance industry for more than 40 years, helping many families secure much needed life insurance coverage and peace of mind. She approaches each case, like each person, individually. She is certified in EKG interpretations, has passed all three of the Academy of Life Insurance Underwriting exams and many LOMA exams.

Underwriting Blood Tests Cardiology