title: Effects of nicorandil on the reduction of BNP levels in patients with chronic kidney disease.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) still frequently experience cardiovascular events despite recent progress in treatment. We examined whether nicorandil, a hybrid nitrate and adenosine triphosphate-sensitive potassium channel opener, could improve a biomarker and physiological markers of cardiovascular events.
  
  
  METHODS
  Patients with advanced stage CKD (stage III-V with or without peritoneal dialysis) were included in this trial if they were considered at high risk for cardiovascular events [past history of cardiovascular diseases, past history of coronary angiography, presence of endothelial dysfunction measured by reactive hyperemia peripheral arterial tonometry, and presence of high brain natriuretic peptide (BNP) values]. Patients were randomly assigned to be treated with or without oral nicorandil, 15 mg/day. BNP values and endothelial function (augmentation index, pulse wave velocity, and reactive hyperemia peripheral arterial tonometry) before and 1 month after the initiation of the trial were assessed.
  
  
  RESULTS
  Nineteen patients (15 men, 4 women) with a mean age of 61 ± 10 (SD) years were included. The median baseline BNP value was 75.3 (interquartile range, 32.1-138.8) pg/ml, and the BNP level was significantly reduced in the nicorandil group (P < 0.05). Regression analysis demonstrated that only the use of nicorandil is related to a decrease of BNP levels [standardized β coefficient, -75.1 (95% CI, -19.7 to -130.6), P = 0.01]. There were no significant changes in the rest of the parameters in the nicorandil group in comparison to the control group. The change in BNP levels was correlated with changes in the augmentation index (P < 0.01) and central pulse pressure (P = 0.03).
  
  
  CONCLUSIONS
  Nicorandil treatment may reduce the level of BNP by reducing the central blood pressure in CKD patients.
authors.affiliation: Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, B6, 2-2 Yamada-oka, Suita, Osaka 585-0871, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kimura
authors.forename: Harumi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Kazunori
authors.initials: K
authors.lastname: Inoue
authors.forename: Noritaka
authors.initials: N
authors.lastname: Kawada
authors.forename: Isao
authors.initials: I
authors.lastname: Matsui
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nagasawa
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.forename: Maki
authors.initials: M
authors.lastname: Shinzawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakata
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hamono
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Isaka
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002908:Chronic Disease; D015536:Down-Regulation; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D007564:Japan; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D020108:Nicorandil / Q000008:administration & dosage / Q000627:therapeutic use*; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000187:drug effects; D012039:Regional Blood Flow / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D020108:Nicorandil