title: Renal function and neurohormonal changes following intravenous infusions of nitroglycerin versus nesiritide in patients with acute decompensated heart failure.
abstract: BACKGROUND
  Rises in serum creatinine and efficacy have been reported as dose-related effects of nesiritide and nitroglycerin in acute decompensated heart failure (ADHF). However, no study has evaluated the comparative safety, efficacy, and biomarkers of optimally dosed nesiritide versus nitroglycerin in ADHF.
  
  
  RESULTS
  Eighty-nine ADHF patients were prospectively randomized to receive either nesiritide (0.01 μg kg(-1) min(-1) ± bolus) or nitroglycerin (maximally tolerated doses by standard protocol). Blood urea nitrogen (BUN), and creatinine were obtained during 48 hours of intravenous infusion. B-Type natriuretic peptide (BNP) and N-terminal (NT) proBNP concentrations were measured during hospitalization. There were no significant differences in BUN, serum creatinine, creatinine clearance, or hospitalization and mortality. Although concentrations of BNP and NT-proBNP were significantly decreased over time, the comparative reductions between the 2 vasodilators were similar.
  
  
  CONCLUSIONS
  Nesiritide and nitroglycerin produce similar hemodynamic effects, do not worsen markers of renal function, and produce significant, yet similar, reductions in neurohormones over time. Both nitroglycerin at maximally titrated doses and nesiritide at standard doses are safe and effective in patients with ADHF who require vasodilator therapy.
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, California 91766, USA. schow@westernu.edu
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Chow
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Barr
authors.forename: Jessica
authors.initials: J
authors.lastname: Peng
authors.forename: Eric
authors.initials: E
authors.lastname: Chew
authors.forename: Firooz
authors.initials: F
authors.lastname: Pak
authors.forename: Ryan
authors.initials: R
authors.lastname: Quist
authors.forename: Paryus
authors.initials: P
authors.lastname: Patel
authors.forename: J Herbert
authors.initials: JH
authors.lastname: Patterson
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Heywood
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D018377:Neurotransmitter Agents / Q000097:blood*; D005996:Nitroglycerin / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents; D020097:Natriuretic Peptide, Brain; D005996:Nitroglycerin