A landmark consensus statement establishes natriuretic peptides (BNP/NT-proBNP) as both essential diagnostic biomarkers and therapeutic targets in heart failure, with direct peptide therapies and ARNIs now central to treatment.
3 societies, 1 consensusThis joint statement from the European, American, and Japanese heart failure societies represents the most authoritative global consensus on using natriuretic peptides for heart failure diagnosis and treatment.
What the researchers found
This trilateral scientific statement from three major heart failure societies provides a comprehensive framework for natriuretic peptides (BNP and NT-proBNP) in heart failure management. Key roles include: (1) BNP/NT-proBNP as the primary diagnostic biomarkers for heart failure with complementary prognostic value, (2) natriuretic peptide-guided therapy to optimize treatment, and (3) therapeutic applications including nesiritide (recombinant BNP), carperitide (ANP), and angiotensin receptor-neprilysin inhibitors (ARNIs like sacubitril/valsartan) that work by increasing endogenous natriuretic peptide levels.
Why it matters
Natriuretic peptides have evolved from simple diagnostic biomarkers to playing a central therapeutic role in heart failure management. The introduction of ARNIs — which boost natriuretic peptide levels by inhibiting their breakdown — has transformed heart failure treatment and underscored the direct cardiovascular protective properties of these peptides. This consensus statement from three international heart failure societies establishes the definitive framework for how natriuretic peptides should be used in clinical practice.
How the study worked
Expert consensus statement developed through the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. The document synthesizes evidence from basic research, clinical trials (including trials using natriuretic peptides as inclusion criteria or endpoints), and therapeutic studies.
Who was studied
Patients with acute and chronic heart failure across the spectrum of ejection fractions
What this study cannot tell us
As a consensus statement rather than a systematic review or meta-analysis, the document reflects expert interpretation of existing evidence. Specific gaps in knowledge are acknowledged, including optimal natriuretic peptide thresholds across different populations, the role of natriuretic peptide-guided therapy in HF with preserved ejection fraction, and the impact of obesity and renal dysfunction on natriuretic peptide levels.
How to read the evidence
This is an expert consensus statement from three major international heart failure societies, representing the highest level of clinical guidance. It synthesizes evidence from randomized controlled trials, biomarker studies, and therapeutic trials, though as a consensus document it reflects expert interpretation rather than independent systematic review.
When this study was published
Published in 2023, this is the most current international consensus statement on natriuretic peptides in heart failure, incorporating the latest evidence on ARNI therapy and natriuretic peptide-guided treatment strategies.
The bigger picture
Natriuretic peptides represent one of the most successful translational stories in cardiovascular medicine — from the discovery of their biology to their use as the gold-standard heart failure biomarker to their therapeutic exploitation via ARNIs. The success of sacubitril/valsartan (which prevents natriuretic peptide breakdown) validated the concept that boosting endogenous peptide systems can be as effective as blocking harmful pathways. This paradigm has implications for how we think about peptide-based therapeutics across all of medicine.
Questions still open
- Can natriuretic peptide-guided therapy improve outcomes specifically in heart failure with preserved ejection fraction (HFpEF)?
- How should natriuretic peptide thresholds be adjusted for obesity, renal dysfunction, and different ethnic populations?
- Will next-generation natriuretic peptide therapies (beyond ARNIs) further improve heart failure outcomes?
Common questions
What are natriuretic peptides and why are they important for the heart?
How do ARNIs like sacubitril/valsartan use natriuretic peptides to treat heart failure?
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.
European journal of heart failure, 25(5), 616-631
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.. European journal of heart failure, 25(5), 616-631. https://doi.org/10.1002/ejhf.2848