NPPB and pulmonary arterial hypertension: In the United States, although it is uncertain whether African Americans withSSc are more likely to develop PAH, those who do tend to present with more severedisease, as demonstrated by worse functional class, higher B-type natriuretic peptide (BNP), a lower cardiacindex, higher PVR, and worse RV function, all corresponding to worse survival, ascompared to Americans of European descent [41].