A normal BNP does not reliably exclude pulmonary hypertension in interstitial lung disease

Pulmonary hypertension (PH) frequently develops among patients with interstitial lung disease (ILD) and leads to a markedly worsened prognosis (14% survival at 5 years) [1] and increased morbidity [2, 3]. Despite its high prevalence in ILD (10–20% at diagnosis [2]), there is no standardized screening tool for development of PH-ILD [2, 4]. Furthermore, it can be challenging to determine longitudinally whether worsening symptomatology in a patient with ILD is attributable to progression of underlying lung disease or to the development of a pulmonary vasculopathy. With publication of the INCREASE trial [5], there is a strong incentive to identify patients with PH earlier in their disease course.