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Am Fam Physician. 2007;75(3):422

AHRQ Evaluates Peptides as Determinants for Patients with Heart Failure

B-type natriuretic peptide (BNP) and N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) are markers for heart failure diagnosis, prognosis, and treatment. To further study these peptides, the Agency for Healthcare Research and Quality (AHRQ) systematically reviewed the available literature. The findings are available online at

In a search of Medline, CINAHL, EMBASE, AMED, and Cochrane Central from 1989 to February 2005, a total of 72 studies showed a relationship between BNPs and a determinant. A total of 103 determinants were found, including sex, age, treatment, disease, and biochemical and physiologic measures.

Pooled sensitivity and specificity values were 92 percent and 65 percent, respectively, for NT-proBNP and 94 percent and 66 percent for BNP. There was little difference between emergency, primary care, and specialized clinical settings. Further, BNP and NT-proBNP were independent indicators of mortality and other cardiac composite end points in patients at risk of coronary artery disease (CAD), diagnosed CAD, and diagnosed heart failure.

Although some studies showed that therapy reduced NT-proBNP and BNP levels, the relationship between such changes and outcomes was limited and not consistent. Therefore, AHRQ concludes that there is insufficient evidence to determine if BNP and NT-proBNP levels show changes in response to therapy for chronic heart failure.

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