Natriuretic Peptide Goal-Directed Therapy: Are We There Yet?

Plasma B-type cardiac natriuretic peptides reflect cardiac structure and function, and have a proven role in the diagnosis of acute heart failure. Serial changes in plasma B-type cardiac natriuretic peptides parallel prognosis in chronic heart failure suggesting that intensified treatment directed at reducing B peptide concentrations may improve outcomes in heart failure (HF). This approach has been assessed in randomized trials conducted over the last 15 years. Meta-analyses of both summary and individual patient data indicate that adjustment of treatment in chronic HF according to serial B-type peptide measurements is likely to safely reduce all-cause mortality and admissions with HF. We await definitive data from adequately powered trials in both HF with and without preserved ejection fraction. However, existing evidence supports the use of this strategy in patients with HF aged under 75 years with systolic dysfunction.