Another limitation is that the levels of BNP at baseline could possibly be influenced by medication (use of diuretics or angiotensin-converting enzyme [ACE] inhibitors), potentially decreasing BNP production.32 Conversely, conditions like chronic obstructive pulmonary disease (COPD) or diabetes can elevate BNP levels.33,34 However, in this study, BNP levels showed no difference between diuretics/ACE inhibitor users and non-users, and between people with and without diabetes. Here, ACE is linked to diabetes mellitus.