The emerging role of natriuretic peptides in the diagnosis and treatment of decompensated heart failure.

B-type natriuretic peptide (BNP) is a cardiac neurohormone and is released as prepro BNP and then enzymatically cleaved to the N-terminal proBNP (NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP and NT-proBNP have been used to identify patients with heart failure (HF). Clinical considerations for these tests include their half-lives in plasma, dependence on renal function for clearance, interpretation of their units of measure, and the rapid availability of the test results. The BNP assay is currently used as a diagnostic and prognostic aid in HF. In general, a BNP level below 100 pg/mL excludes acutely decompensated HF. Recombinant, human BNP (nesiritide) is an approved intravenous treatment for acute, decompensated HF. This paper reviews the literature concerning the use of this peptide as a diagnostic test and as an intravenous therapy.