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FDA Approved Cardiovascular & Renal

BNP

also known as: B-type Natriuretic Peptide, Brain Natriuretic Peptide, NT-proBNP

The heart failure biomarker — an endogenous cardiac peptide whose blood levels are the gold standard for diagnosing and monitoring heart failure severity.

A 32-amino-acid peptide hormone secreted by ventricular cardiomyocytes under mechanical stress, driving natriuresis and vasodilation, and used as the primary biomarker for heart failure diagnosis and monitoring.

Mechanism of action

Binds natriuretic peptide receptor A (NPR-A), activating guanylyl cyclase and raising intracellular cGMP. Effects: vasodilation, natriuresis, diuresis, suppression of RAAS and sympathetic nervous system, anti-fibrotic and anti-hypertrophic cardiac effects.

Primary uses

  • Heart failure diagnosis and monitoring (biomarker)
  • Dyspnea differential diagnosis
  • Prognosis in acute coronary syndromes
  • Target of neprilysin inhibition (Entresto mechanism)

Typical dosing

(diagnostic blood test)

Not administered therapeutically in current practice. Nesiritide (recombinant BNP) was dosed at 2 mcg/kg bolus + 0.01 mcg/kg/min infusion but is rarely used.

Regulatory status

BNP is FDA-approved as a diagnostic biomarker for heart failure (Triage BNP, Biosite, 2000). Nesiritide (recombinant BNP) was previously FDA-approved therapeutically but fell out of favor. Sacubitril/valsartan (Entresto) works by raising endogenous BNP.

References

  1. [review] Maisel AS, et al. "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure." N Engl J Med, 2002;347:161-167.

Related peptides

Nesiritide

Natrecor — the first recombinant natriuretic peptide drug for acute heart failure. FDA-approved August 2001 based on short-term dyspnea relief, became one of the most controversial drugs of the 2000s after 2005 meta-analyses raised safety concerns; ASCEND-HF (2010, n=7,141) eventually settled the safety debate but demonstrated only marginal clinical benefit. Janssen discontinued manufacturing February 2018; no longer commercially available in the US.

Carperitide

⚠ Approved in Japan only (1995). The Daiichi Sankyo recombinant hANP has been used in >30,000 pooled patients with acute heart failure in Japanese registries, but its overall mortality effect remains contested — 2024 meta-analyses suggest a possible increase in in-hospital mortality, while other pooled analyses suggest benefit at low doses.

Ularitide

⚠ Phase 3 failure. Cardiorentis's ularitide was the most recent Western attempt to develop an IV natriuretic peptide for acute heart failure. TRUE-AHF (NEJM 2017, n=2,157) failed both the mortality and hemodynamic co-primary endpoints; development was discontinued shortly after. Reinforced a now-consistent pattern of IV natriuretic peptides showing biochemical and hemodynamic effects but failing to improve clinical outcomes.
Disclaimer

This entry is for educational purposes only and does not constitute medical advice. Dosing information reflects published regulatory or research data and is not a recommendation. Many compounds described here are not approved for human use in the United States. Consult a licensed medical professional before considering any peptide therapy.