Nesiritide added to standard care favorably reduces systolic blood pressure compared with standard care alone in patients with acute decompensated heart failure.
The Prospective Randomized Outcomes study of Acutely decompensated Congestive heart failure Treated Initially as Outpatients with Nesiritide (PROACTION) trial evaluated the safety of nesiritide administration in the emergency department in patients with decompensated heart failure. Patients (N=237) were treated for at least 12 hours with standard care plus either intravenous nesiritide or placebo. Compared to placebo, nesiritide favorably decreased systolic blood pressure (SBP) in patients with elevated baseline SBP, without negatively impacting patients with lower baseline SBP (SBP, >140 mm Hg: nesiritide, -28.7 mm Hg, vs placebo, -8.4 mm Hg [P<.001]; SBP, 101-140 mm Hg: nesiritide, -12.3 mm Hg, vs placebo, -5 mm Hg [P<.017]; SBP, <101 mm Hg: nesiritide, -1.2 mm Hg vs placebo, +16.7 mm Hg [P<.03]). Both treatment groups had similar incidences of symptomatic and asymptomatic hypotension. These data demonstrate that early administration of nesiritide in the emergency department is a safe and effective treatment of heart failure.
Peacock
W Franklin
WF
Department of Emergency Medicine, The Cleveland Clinic Foundation, OH 44195, USA. peacocw@ccf.org
Emerman
Charles L
CL
Silver
Marc A
MA
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000627:therapeutic use*
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain