BNP in hormone-guided treatment of heart failure.
The pharmacotherapy of heart failure has become complex. Angiotensin-converting enzyme inhibitors (or angiotensin II receptor blockers), beta-blockers, spironolactone, diuretics and digoxin can be prescribed concurrently. Endothelin antagonists and combined inhibitors of converting enzyme and neutral endopeptidase are under investigation. Optimal dosing will become increasingly difficult to judge. Plasma brain natriuretic peptide (BNP) indicates the severity of left ventricular dysfunction. The C-terminal bioactive peptide and N-terminal BNP (N-BNP) circulate at concentrations related to cardiac status. We proposed that plasma levels of N-BNP would provide an index to guide drug treatment in established heart failure. Sixty-nine patients were randomized to treatment adjusted according to clinical criteria or plasma N-BNP. Hormone-guided therapy resulted in fewer clinical end points than did clinical management. This encourages further exploration of hormone guidance of anti-heart failure therapy, which could be extended to patients with preserved ejection fraction, in addition to those with established systolic dysfunction.
Richards
A Mark
AM
Christchurch Cardioendocrine Research Group, Dept Medicine, Christchurch School of Medicine, Riccarton Avenue, PO Box 4345, Christchurch, New Zealand.
Lainchbury
John G
JG
Nicholls
M Gary
MG
Troughton
Richard W
RW
Yandle
Timothy G
TG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood*; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D016903:Drug Monitoring; D006331:Heart Diseases / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016032:Randomized Controlled Trials as Topic; D013148:Spironolactone / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000097:blood
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone; D004077:Digoxin