The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent ‘pancardiac’ target organ damage BNP/N-BNP could become for the heart what microalbuminuria is for the kidneyThe opinions expressed in this article are necessarily not those of the Editors of European Heart Journal or of the European Society of Cardiology.

Brain natriuretic peptide (BNP) or N-terminal pro-BNP (N-BNP) now appears to be the best independent predictor of cardiovascular mortality over and above the conventional ones like blood pressure. This may be because a high BNP/N-BNP is identifying any form of asymptomatic cardiac target organ damage (TOD) [especially silent ischaemia, left ventricular hypertrophy (LVH), left atrial dilatation/atrial fibrillation (LAD/AF) and LV systolic dysfunction (LVSD)]. There are strong hints that BNP/N-BNP will also identify those who are going to develop LVH, LAD/AF, and LVSD in a few years' time. Thus, the prospects are good that BNP/N-BNP could be used to identify ‘pancardiac’ TOD, even when it is silent and that this information could be ‘harnessed’ to improve primary prevention. BNP/N-BNP could become to the heart what microalbuminuria is to the kidneys, i.e. an indicator of early, silent TOD.