title: Effect of nesiritide in combination with standard therapy on serum concentrations of natriuretic peptides in patients admitted for decompensated congestive heart failure.
abstract: OBJECTIVE
  The objective of this study is to determine the effect of nesiritide (human recombinant BNP [hBNP]) in combination with standard therapy on the concentrations of B-type natriuretic peptide (BNP) and N-terminal probrain natriuretic peptide (NT-proBNP).
  
  
  BACKGROUND
  B-type natriuretic peptide is synthesized in cardiac ventricles as a prohormone (108 amino acids) and when released into peripheral circulation is cleaved into the active hormone BNP (amino acids 77-108) and an inactive amino terminal fragment NT-proBNP (amino acids 1-76).
  
  
  METHODS
  Three groups of patients with acutely decompensated congestive heart failure (CHF) received nesiritide for 24, 36, or 48 hours (n = 5, 7, and 7, respectively) in addition to standard therapy. Serial blood samples were collected. B-type natriuretic peptide and NT-proBNP were measured.
  
  
  RESULTS
  To correct for positive skew, natriuretic peptide concentrations were log transformed. The mean baseline (prenesiritide), 6-, 12-, and 24-hour infusion, and 6-, 12-, and 24-hour postinfusion concentrations of BNP were 1000, 2300, 2200, 1700, 580, 640, and 740 pg/mL, respectively (n = 19). The 6- and 12-hour postinfusion concentrations of BNP were significantly lower (< 0.05) than baseline. The mean baseline, 60-, 120-, and 24-hour infusion, and 6-, 12-, and 24-hour postinfusion concentrations of NT-proBNP were 6600, 6500, 5800, 4300, 4100, 4300, and 5100 pg/mL, respectively (n = 19). From the time point 24 hours after initiation of therapy through 12 hours postinfusion, the mean NT-proBNP concentration was significantly (< 0.05) lower than baseline.
  
  
  CONCLUSIONS
  Nesiritide, in combination with standard therapy, significantly lowered the endogenous concentrations of natriuretic peptides during infusion and after dosing was completed.
authors.affiliation: Veterans Affair Medical Center, San Diego, California, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fitzgerald
authors.forename: Rosemary
authors.initials: R
authors.lastname: Cremo
authors.forename: Nancy
authors.initials: N
authors.lastname: Gardetto
authors.forename: Albert
authors.initials: A
authors.lastname: Chiu
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies
chemical_list: D045283:Natriuretic Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain