Low or normal BNP levels can mask HFpEF diagnosis because this form of heart failure produces less wall stress and degrades natriuretic peptides faster.
Normal BNP does not rule out HFpEFUnlike other forms of heart failure, HFpEF can present with low or normal natriuretic peptide levels, leading to missed diagnoses
What the researchers found
BNP and NT-proBNP levels may be normal in HFpEF patients due to reduced myocardial wall stress, increased peptide clearance, and medication effects, creating a significant diagnostic gap.
Why it matters
HFpEF is increasingly common, especially with rising obesity rates. If normal BNP levels falsely reassure clinicians, patients may not receive timely diagnosis and treatment for a serious condition.
The numbers in context
BNP and NT-proBNP may be normal in HFpEF. Factors: obesity, reduced wall stress, enhanced NP clearance, NPR-C-mediated degradation. NT-proBNP levels vary by ethnicity. Normal ranges may miss HFpEF in patients under 75.
How the study worked
Review article examining the diagnostic limitations of natriuretic peptide testing in HFpEF and factors contributing to false-negative results.
Who was studied
One patient with HFpEF and normal BNP levels
What this study cannot tell us
Review article without new clinical data. The exact rate of false-negative BNP results in HFpEF is not precisely quantified.
How to read the evidence
Review of existing literature highlighting a well-recognized diagnostic limitation. The clinical implications are supported by multiple prior studies.
When this study was published
Published in 2025, addressing a growing diagnostic challenge as HFpEF prevalence increases.
The bigger picture
As HFpEF becomes the dominant form of heart failure worldwide, the limitations of relying on a single biomarker become more consequential. This review pushes for a more comprehensive diagnostic approach.
Questions still open
- What alternative biomarker panels or diagnostic criteria should replace BNP-dependent algorithms for HFpEF?
- How often do patients with HFpEF have completely normal natriuretic peptide levels?
Common questions
Can you have heart failure with a normal BNP test?
What should doctors do if they suspect HFpEF but BNP is normal?
Read the original research
Heart Failure With Preserved Ejection Fraction and Low B-type Natriuretic Peptide: A Diagnostic Dilemma.
Cureus, 17(4), e82602
Citation
Paul, Tyler; Nadeem, Amin Ur Rehman; Naqvi, Syed M; Liu, Jason; Ali, Khaled A. (2025). Heart Failure With Preserved Ejection Fraction and Low B-type Natriuretic Peptide: A Diagnostic Dilemma.. Cureus, 17(4), e82602. https://doi.org/10.7759/cureus.82602