[Comparison of the effects of intravenous recombinant human brain natriuretic peptide and nitroglycerin in patients with decompensated acute heart failure: a multicenter, randomized, open-label, parallel-design study].
OBJECTIVE
To compare the efficacy and safety of intravenous infusion recombinant human brain natriuretic peptide (rhBNP) versus nitroglycerin (NIT) in treating patients with decompensated acute heart failure.


METHODS
A total of 209 patients characterized of decompensated acute heart failure were enrolled in this multicenter, randomized, open-label, parallel-design study. The patients were randomly allocated to catheter group and non-catheter group (depending on the use of Swan-Ganz). Each group was then randomly assigned to receive rhBNP (0.15 microg/kg bolus intravenous injection followed by 0.0075 microg.kg(-1).min(-1) for 24 hours, n = 105) or NIT (starting at 10 microg/min and increasing 5 microg/min each time till clinical effective dose for 24 hours, n = 104). Blood pressure, heart rate, dyspnea grade, 24 hours fluid in- and output and improvement in patient symptoms and signs were evaluated and adverse events were documented.


RESULTS
Urine output was significantly increased after both rhBNP and NIT treatments. Dyspnea and symptom improvements were more significant in rhBNP group compared to NIT group. PCWP and PAP were both decreased after rhBNP and NIT therapies and there was more significant reduction in PCWP and PAP between 30 min and 2 hours in rhBNP group compared to NIT group. However, RAP and CI were similar between the two groups at various time points. The total adverse events were comparable between the two groups (20.0% vs. 19.2%, P > 0.05) and 7 patients withdrew the study due to adverse events (4 in rhBNP and 3 in NIT group).


CONCLUSIONS
rhBNP is superior to nitroglycerin in improving dyspnea and symptoms and decreasing PCWP and PAP in patients with decompensated acute heart failure patients. The safety of rhBNP was comparable to nitroglycerin in treating patients with decompensated acute heart failure.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D055815:Young Adult
D002316:Cardiotonic Agents; D011994:Recombinant Proteins; D020097:Natriuretic Peptide, Brain; D005996:Nitroglycerin