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Abstract: Prognostic values of N-terminal pro-brain natriuretic peptide (NT-proBNP) in myriad diseases have been studied. During the natural progression of atherosclerotic renal artery disease (ARVD) changes of NT-proBNP levels and its significance is not understood. A prospective longitudinal follow-up study was conducted among 61 ARVD patients (77.7±5.2 years old). NT-proBNP was determined at baseline and six month intervals over 25.89±12.44 months and its correlation with death and/or newly occurred CVEs were assessed. Level of NT-proBNP increased from baseline median 210.0pg/mL (25th–75th percentile, 98.0pg/mL–540.0pg/mL) to 900.9pg/mL (25th–75th percentile, 704.5pg/mL–1583.5pg/mL) (p =0.032) at the end of follow-up. Among 44.26% of the cohort (n =27) NT-proBNP level ≥450pg/mL was detected, which 6 deaths happened (22.22% death rate) and CVEs occurred to 62.96% of patients, comparing to 0% death rate (p =0.077) and 8.82% affected by CVEs (p =0.019) in other 55.74% of cohort (n =34) whose NT-proBNP <450pg/mL. Kaplan–Meier analysis showed that NT-proBNP level ≥450pg/mL was a risk factor related to CVEs (HR=3.96, p =0.03). Cox regression analysis found NT-proBNP level ≥450pg/mL was an independent risk factor of CVEs (HR=5.12, p =0.022) after adjustment of body mass index, blood pressure, kidney function. The negative predictive value was 90.9% of NT-proBNP levels ≥450pg/mL for new CVEs. NT-proBNP levels diverge throughout ARVD natural progression in elderly males over 75 years of age. Elevated NT-proBNP level of ≥450pg/mL was predictive for CVEs with 90.9% of negative predictive value. [Copyright &y& Elsevier]