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Natriuretic peptide guided therapy for management of patients with heart failure does not show improvement compared with usual medical therapy alone
  1. Julie McLellan,
  2. Clare Bankhead
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Mrs Julie McLellan, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK; julie.mclellan{at}

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Commentary on: Felker GM, Anstrom KJ, Adams KF, et al. Effect of natriuretic peptide-guided therapy on hospitalisation or cardiovascular mortality in high-risk patients with heart failure and reduced ejection fraction: a randomized clinical trial. JAMA 2017;318:713–720.


Natriuretic peptides (NPs), a collective term for B-type natriuretic peptide (BNP) and N(or amino)-terminal pro-B-type natriuretic peptide (NT-proBNP), are released by the myocardium in response to pressure or fluid overload. In patients with heart failure (HF) the NP levels are raised. NP testing is currently used in diagnosis and prognosis, but its role in guiding HF treatment remains uncertain. The guidelines do not currently recommend NP-guided treatment. Previous clinical trials and meta-analyses have researched NP-guided treatment with mixed results.1–6 Felker et al, in the Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) study, aimed to …

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