B‐type natriuretic peptide and heart failure: what can we learn from clinical trials?

Summary The B ‐type natriuretic peptide ( BNP ) may favour natriuresis and diuresis, making it an ideal drug to aid in diuresing a fluid‐overloaded patient with poor or worsening renal function. Several randomized clinical trials have tested the hypothesis that infusions of pharmacological doses of BNP to acute heart failure ( HF ) patients may enhance decongestion and preserve renal function in this clinical setting. Unfortunately, none of these has resulted in a better outcome. The current challenge for BNP research in acute HF lies in a failure of concept and reluctance to abandon a demonstrably ineffectual research model. Future success will necessitate a detailed understanding of the mechanism of action of BNP as well as a better integration of basic and clinical science.