ISBN: 978-1-4731-3093-7 might be related to heart failure, discuss with a physician with a subspeciality interest in heart failure. [2018] Be aware that: obesity, African or African-Caribbean family origin, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors , beta-blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonist (MRAs) can reduce levels of serum natriuretic peptides high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction ], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver). [2010, Research recommendations What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with IIIb, IV or V chronic kidney disease? What is the optimal threshold for NT-proBNP for the diagnosis of heart failure in people with suspected heart failure: 400 ng/ml or 125 ng/ml? Relative values of different outcomes The investigation into BNP and NT-proBNP in the diagnosis of heart failure was approached by considering both clinical effectiveness and diagnostic accuracy. Within each approach, evidence was sought separately for the general suspected heart failure population, as well as people with atrial fibrillation (AF) and suspected heart failure, and people with chronic kidney disease (CKD) and suspected heart failure. The analysis was broken down into three separate chapters for each population, each of which included two separate review questions. The clinical effectiveness reviews aimed to establish whether using NT- proBNP is more effective than using BNP in terms of improving patient outcomes, in each population. The committee agreed that the critical outcomes were all-cause mortality, quality of life and unplanned hospitalisations. 