European HF Guidelines indeed recommend the dosage of natriuretic peptides (NP) in patients presenting with acute onset or worsening of symptoms or signs compatible with HF and the optimal exclusion cut-off point is 300 pg/ml for NT-proBNP and 100 pg/ml for BNP.[1] Although elevated NT-proBNP levels may reflect a functional and structural cardiac impairment, the interpretation of the results can be confounded by the presence of other conditions, such as renal dysfunction, atrial fibrillation and anemia that are typical of the older people. This evidence concerns the gene NPPB and Abnormal renal physiology.