About NT-proBNP

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NT-proBNP is a blood test that may be performed as part of the life insurance underwriting process. The test measures hormone levels in the blood. If those hormone levels are higher than expected, it often indicates a strain to the heart.

What Does the NT-proBNP Test Measure?

When the heart muscle experiences cardiac stress, it releases more of a hormone called N-terminal pro-B-type natriuretic peptide (commonly called NT-proBNP). Normally, levels of this hormone are quite low. An increased level of NT-proBNP is typically a response to increased blood volume, fluid retention, or ischemia. These stressors may indicate an underlying condition such as congestive heart failure, coronary artery disease, or left ventricular dysfunction.

During the NT-proBNP blood test, the NT-proBNP hormone is split into two parts: a biologically active peptide that helps the body regulate salt and fluids, and a non-stable peptide. The biologically active peptide has a half-life of 18 minutes, during which this test can be performed.

When Is This Test Used?

The FDA approved this test to help assess the risk of future cardiac events. A 2005 study published in the New England Journal of Medicine found this test to be the most predictive indicator of overall mortality in patients with stable coronary disease. In December of 2016, an article published in the Journal of the American College of Cardiology called this test the “gold standard biomarker in heart failure.”

This test can be used as a screening tool during the underwriting process in several cases:

  • The proposed insured is age 59+ and has applied for a large policy. The NT-proBNP test is sometimes used in lieu of a resting EKG or stress EKG.
  • The proposed insured presents with a history of coronary artery disease (CAD); the test can help identify ongoing cardiac stress or congestive heart failure.
  • The proposed insured presents with a history of shortness of breath or edema; the test can help identify congestive heart failure (CHF) as a cause.


Elevated NT-proBNP levels don’t always indicate a heart condition. The underlying cause could be unrelated to cardiac stress, such as a lung injury, COPD, chronic renal failure, or cirrhosis. Age, sex, and medication can also affect a proposed insured’s NT-proBNP levels.

NT-proBNP test results are used in combination with other cardiovascular risk factors in the underwriting evaluation. If the test reveals elevated NT-proBNP levels, underwriting may request further evaluation if they see this is a new and undiagnosed concern with the proposed insured’s doctor. Additional tests may include another blood test, a stress test, or an echocardiogram.

Our NT-proBNP questionnaire will help you gather the information we'll need to help evaluate your case.

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