NPR1 and hydrops fetalis: In this regard, a role could also be played by a greater availability of NPR-A to be coupled by higher active NP and activate the guanylate cyclase pathway with a higher production of cGMP, which appears indeed to be the case in a sub-population of the PARADIGM-HF in which urinary cGMP was measured and indeed it was selectively increased in the group treated with LCZ696 [218].