Three major international heart failure societies jointly affirm natriuretic peptides (BNP and NT-proBNP) as essential tools for diagnosing heart failure, predicting outcomes, and guiding treatment — including their growing role as therapeutic targets through ARNI drugs.
3 major societies, 1 unified frameworkThe European, American, and Japanese heart failure societies jointly created this comprehensive guide — the first trilateral consensus on how natriuretic peptides should be used across the full spectrum of heart failure care.
What the researchers found
This trilateral scientific statement from the European, American, and Japanese heart failure societies provides a comprehensive framework for how natriuretic peptides — specifically BNP and NT-proBNP — should be used in diagnosing and managing heart failure. The document covers four major areas: the biology and cardiovascular protective effects of natriuretic peptides; their established role as diagnostic and prognostic biomarkers in both acute and chronic heart failure; their use as endpoints in clinical trials and as guides for therapy adjustment; and their direct therapeutic applications through drugs like nesiritide (recombinant BNP), carperitide (ANP), and ARNIs (sacubitril/valsartan).
The statement emphasizes that with the development of ARNIs — which work by preventing the breakdown of natriuretic peptides — these peptides have gained importance not just as biomarkers but as therapeutic agents in their own right.
Why it matters
Natriuretic peptides are the single most important blood test in heart failure diagnosis. This consensus statement from three major international societies represents the authoritative global perspective on how to use them — from initial diagnosis to guiding treatment decisions. The emergence of ARNI therapy (sacubitril/valsartan) has transformed natriuretic peptides from passive biomarkers into active therapeutic targets, making this framework especially relevant.
The numbers in context
Consensus from 3 international societies · Covers BNP + NT-proBNP · 4 focus areas: biology, biomarkers, therapy, future directions · 28 expert authors
How the study worked
Expert consensus scientific statement developed through the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and Japanese Heart Failure Society. Synthesizes existing evidence across diagnosis, prognosis, clinical trials, and therapeutics.
Who was studied
Expert consensus document (not a clinical trial)
What this study cannot tell us
As a consensus statement rather than a systematic review, it reflects expert opinion and may be subject to selection bias in evidence cited. Clinical practice recommendations may vary by region and healthcare system. Rapidly evolving therapeutics may outpace some recommendations.
How to read the evidence
Rated high: expert consensus statement from three major international cardiology societies, synthesizing decades of clinical evidence. While not a systematic review, it represents the highest level of authoritative clinical guidance in the field.
When this study was published
Published in 2023. This is a current and authoritative document reflecting the latest evidence on natriuretic peptide use in heart failure, including the impact of ARNI therapy.
The bigger picture
Natriuretic peptides are arguably the most clinically successful peptide biomarkers in medicine. This consensus statement captures a pivotal moment: these peptides are no longer just diagnostic tools — they're now treatment targets. ARNI therapy works by blocking the enzyme that destroys natriuretic peptides, effectively boosting the body's own cardioprotective peptide system. This dual role as biomarker and therapeutic target is unique in cardiovascular medicine.
Questions still open
- Can natriuretic peptide-guided therapy reliably improve outcomes compared to standard clinical management across all heart failure subtypes?
- Will newer natriuretic peptide-enhancing therapies beyond ARNIs emerge, and how will they change the diagnostic landscape?
- How should BNP versus NT-proBNP testing be standardized globally for consistent clinical decision-making?
Common questions
What are natriuretic peptides and why do doctors test for them?
How have natriuretic peptides gone from blood tests to treatment targets?
Read the original research
Natriuretic Peptides: Role in the Diagnosis and Management of Heart Failure: A Scientific Statement From the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society.
Journal of cardiac failure, 29(5), 787-804
Citation
Tsutsui, Hiroyuki; Albert, Nancy M; Coats, Andrew J S; Anker, Stefan D; Bayes-Genis, Antoni; Butler, Javed; Chioncel, Ovidiu; Defilippi, Christopher R; Drazner, Mark H; Felker, G Michael; Filippatos, Gerasimos; Fiuzat, Mona; Ide, Tomomi; Januzzi, James L; Kinugawa, Koichiro; Kuwahara, Koichiro; Matsue, Yuya; Mentz, Robert J; Metra, Marco; Pandey, Ambarish; Rosano, Giuseppe; Saito, Yoshihiko; Sakata, Yasushi; Sato, Naoki; Seferovic, Petar M; Teerlink, John; Yamamoto, Kazuhiro; Yoshimura, Michihiro. (2023). Natriuretic Peptides: Role in the Diagnosis and Management of Heart Failure: A Scientific Statement From the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society.. Journal of cardiac failure, 29(5), 787-804. https://doi.org/10.1016/j.cardfail.2023.02.009