From the Research
Yes, a patient with heart failure with preserved ejection fraction (HFpEF) who is taking torsemide daily can have a Brain Natriuretic Peptide (BNP) level less than 100 pg/mL. While BNP is typically elevated in heart failure patients, those with HFpEF often have lower BNP levels compared to patients with reduced ejection fraction. Torsemide, a loop diuretic, helps manage fluid overload by increasing urine output, which can lead to reduced cardiac wall stress and subsequently lower BNP levels. Several factors can influence BNP levels in HFpEF patients, including obesity (which tends to lower BNP), kidney function, age, and how well the heart failure is controlled with medications. It's essential to consider the clinical context, including symptoms and other diagnostic findings, when interpreting BNP levels in HFpEF patients, as noted in a recent review published in the Journal of cardiac failure 1. Additionally, a systematic narrative review published in Heart failure reviews in 2024 highlights the challenges in diagnosing HFpEF and the importance of considering multiple factors, including natriuretic peptide levels and echocardiogram findings 2. Some well-managed HFpEF patients on appropriate diuretic therapy like torsemide may maintain relatively normal BNP levels, especially between exacerbations or when their volume status is well-controlled, as supported by the most recent evidence from a review published in JAMA in 2023 3. Key points to consider in the management of HFpEF include:
- The use of sodium-glucose cotransporter type 2 inhibitors as first-line pharmacologic therapy
- The importance of exercise training and diet-induced weight loss in improving functional capacity and quality of life
- The role of diuretics, such as torsemide, in managing fluid overload and improving symptoms
- The need for education in HF self-care to help avoid HF decompensation. Overall, the management of HFpEF should focus on controlling symptoms, improving quality of life, and reducing the risk of hospitalization and mortality, as emphasized in a review published in Clinical research in cardiology in 2018 4.