[The relationship between natriuretic peptides and neprilysin pathways: the clinical simplification against the complexity of biological systems].

A large body of evidence supports the use of natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal proBNP [NT-proBNP]) for the evaluation and management of patients with heart failure over time. Elevated values reflect an enhanced counterregulatory response to hemodynamic stress and are indicative of heart failure severity, thus predicting prognosis. The clinical relevance and result interpretation of natriuretic peptides for monitoring therapy are still debated, and our understanding of their complex nature is still far from being complete. The new data about the clinical efficacy of LCZ696, a combination neprilysin inhibitor and angiotensin receptor blocker recently approved for the treatment of symptomatic chronic heart failure, showed a different susceptibility of BNP and NT-proBNP during therapy. The aim of this article is to discuss the controversial issues concerning the clinical use of cardiac natriuretic peptide measurement, the complex relationship with neprilysin pathways, and the practical implications of LCZ696 therapy for natriuretic peptide testing in clinical practice.