Why is Pro-BNP/ BNP lower in Obesity?

B-type natriuretic peptide (BNP) is a hormone created in response to cardiac wall stretch due to volume or pressure overload. Its precursor molecule is proBNP.

BNP is noted to have numerous effects on different target organs, including:

-Dilatation of afferent renal arterioles while constricting of efferent renal arterioles -> increasing renal filtration to promote diuresis.

-Stimulation of lipolysis.

-Increased insulin secretion.

Why is it lower in obese patients who may be clinically in heart failure?

Thought to be multi-factorial. Mainly driven by upregulation of receptor: NPR-C (driven by increases in proinflammatory IL-6 by adipose tissue) and ubiquitous endopeptidase, Nephrlysin (NEP), resulting in increased degradation and clearance of BNP.

Image Credit: Curr Cardiol Rep (2020) 22:150


  1. Reinmann M, Philippe M. B-type natriuretic peptide and obesity in heart failure: a mysterious but important association in clinical practice. Cardiovasc Med. 2020;23:w02095
  2. Sbolli M, deFilippi C. BNP and NT-proBNP Interpretation in the Neprilysin Inhibitor Era. Curr Cardiol Rep. 2020 Sep 19;22(11):150.
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Dr. C Humphreys

Internal Medicine

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Dr. C Humphreys

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