NPPB and cardiac hypertrophy: Natriuretic peptides (NPs) increase natriuresis and cause vasodilation in response to myocardial stretch secondary to myocardial hypertrophy/fibrosis [8]. In this case report, the patient exhibited classic signs and symptoms of congestive heart failure (CHF) but had a BNP level of only 32 pg/mL - a value inconsistent with CHF.