Importantly, designer natriuretic peptides mimicking the effects of BNP or ANP are currently under development for cardiovascular diseases such as hypertension and heart failure.92 Future studies are required to test the effectiveness of direct modulation (eg, designer natriuretic peptides), indirect modulation, or tailored management (eg, conservative fluid management in high-risk patients) of these pathways to prevent the onset and/or long-term cardiovascular consequences of HDPs. This evidence concerns the gene NPPA and heart failure.