B-type natriuretic peptide and obesity in heart failure: a mysterious but important association in clinical practice
Marie Reinmann, Philippe Meyer
Abstract
Since its discovery in 1988, B-type natriuretic peptide (BNP) and later its amino-terminal counterpart NT-proBNP have been thoroughly investigated and have become an essential clinical tool used in everyday practice for the diagnosis and prognostic assessment of patients with heart failure. However, one of the main pitfalls in the clinical interpretation of BNP/NT-proBNP levels is the concurrent presence of obesity. Many studies have demonstrated that BNP/NT-proBNP levels are lower than expected in obese patients even if the underlying mechanisms have not been fully elucidated yet. This article will review the physiology of BNP/NT-proBNP and their use in the clinical setting. We will then explore the pathophysiology of the association between obesity and low BNP/NT-proBNP levels to conclude with potential clinical consequences in patients with heart failure.