NPPB and heart failure: However, in the phase II, Aldosterone Targeted Neurohormonal Combined with Natriuresis Therapy in Heart Failure (ATHENA-HF) trial, spironolactone failed to meet the primary endpoint of decreasing the 96-h NT-proBNP in patients randomized to spironolactone 100 mg daily vs placebo [or low-dose (25 mg daily)], although NT-proBNP declined considerably in both groups (Table 1) [48].