Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure. A double-blind, placebo-controlled, randomized crossover trial.
BACKGROUND
The pharmacological effects of infusion of human brain natriuretic peptide (hBNP) in patients with severe congestive heart failure have not been characterized previously.


RESULTS
Twenty patients with severe congestive heart failure were randomized in a double-blind, placebo-controlled, crossover trial to receive incremental 90-minute infusions of hBNP (0.003, 0.01, 0.03, and 0.1 microgram/kg per minute) or placebo on 2 consecutive days. At the highest completed dose of the hBNP, mean pulmonary artery pressure decreased from 38.3 +/- 1.6 to 25.9 +/- 1.7 mm Hg; mean pulmonary capillary wedge pressure decreased from 25.1 +/- 1.1 to 13.2 +/- 1.3 mm Hg; mean right atrial pressure decreased from 10.9 +/- 1 to 4.8 +/- 1.0 mm Hg; mean arterial pressure decreased from 85.2 +/- 2.0 to 74.9 +/- 1.7 mm Hg; and cardiac index increased from 2.0 +/- 0.1 to 2.5 +/- 0.1 L/min per square meter (all P < .01 versus placebo). Urine volume and urine sodium excretion increased significantly during hBNP infusion when compared with placebo infusion (90 +/- 38 versus 67 +/- 27 mL/h and 2.6 +/- 2.4 versus 1.4 +/- 1.2 mEq/h, respectively, both P < .05 versus placebo), whereas creatinine clearance and urinary potassium excretion did not change.


CONCLUSIONS
Infusion of incremental doses of hBNP is associated with favorable hemodynamic and natriuretic effects in patients with severe congestive heart failure.
Marcus
L S
LS
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Hart
D
D
Packer
M
M
Yushak
M
M
Medina
N
N
Danziger
R S
RS
Heitjan
D F
DF
Katz
S D
SD
D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000378:metabolism; D006152:Cyclic GMP / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D010919:Placebos; D011188:Potassium / Q000652:urine; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D012964:Sodium / Q000652:urine; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D009419:Nerve Tissue Proteins; D010919:Placebos; D020097:Natriuretic Peptide, Brain; D012964:Sodium; D003404:Creatinine; D006152:Cyclic GMP; D011188:Potassium