{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:53:08Z","timestamp":1791910388553,"version":"4.3.4"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Recent heart failure (HF) guidelines emphasize the importance of recognizing patients with mild elevations in NT\u2010proBNP (N\u2010terminal pro\u2010B\u2010type natriuretic peptide). While NT\u2010proBNP is a key biomarker for diagnosing HF and predicting outcomes, its levels are often lower than expected in HF with preserved ejection fraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Using data from the SUPPORT (Supplemental Benefit of an Angiotensin Receptor Blocker in Hypertensive Patients With Stable Heart Failure Using Olmesartan) trial, we examined the temporal changes in NT\u2010proBNP and long\u2010term outcomes in patients with HF with preserved ejection fraction (left ventricular ejection fraction \u226550%) categorized by NT\u2010proBNP levels (\u226455, 55\u2013125, 125\u2013300, and \u2265300\u2009pg\/mL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 602 patients with HF with preserved ejection fraction, 335 (55.6%) had NT\u2010proBNP &lt;300\u2009pg\/mL (12.5% with \u226455, 18.1% with 55\u2013125, and 25% with 125\u2013300\u2009pg\/mL). Patients with NT\u2010proBNP &lt;300\u2009pg\/mL were younger and had higher body mass index, more ischemic heart disease, less cardiac remodeling, and lower risks of HF hospitalization or all\u2010cause death compared with those with NT\u2010proBNP \u2265300\u2009pg\/mL. Over 3\u2009years, 52 (15.5%) patients with NT\u2010proBNP &lt;300\u2009pg\/mL, including 40 with 125 to 300\u2009pg\/mL, experienced NT\u2010proBNP increase to \u2265300\u2009pg\/mL, accompanied by left ventricular end\u2010systolic enlargement and left ventricular ejection fraction decline. Importantly, these patients had comparable risks of HF hospitalization or all\u2010cause death as compared with those with persistently elevated NT\u2010proBNP \u2265300\u2009pg\/mL (adjusted hazard ratio, 1.08 [95% CI, 0.69\u20131.69]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">More than half of patients with HF with preserved ejection fraction had NT\u2010proBNP &lt;300\u2009pg\/mL at baseline. Patients with mild elevations in NT\u2010proBNP may progress to overt elevations over time, accompanied by cardiac deterioration and adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.041208","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T10:57:32Z","timestamp":1761217052000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Heart Failure With Preserved Ejection Fraction and Lower Natriuretic Peptide: Clinical Characteristics and Change in Natriuretic Peptide Levels"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4217-9497","authenticated-orcid":false,"given":"Kanako","family":"Teramoto","sequence":"first","affiliation":[{"name":"National Cerebral and Cardiovascular Center","place":["Suita, 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