Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide levels in patients with congestive heart failure

Frantz, Robert P.; Olson, Lyle J.; Grill, Diane E.; Moualla, Soundos; Nelson, Sarah; Nobrega, Thomas P.; Hanna, Richard D.; Backes, Richard J.; Mookadam, Farouk; Heublein, Denise M.; Bailey, Kent R.; Burnett, John C.

doi:10.1016/j.ahj.2004.07.036

Cited by 54 publications

(26 citation statements)

References 28 publications

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“…Currently there is conflicting evidence regarding the effect of ␤-blockers on plasma BNP levels. 32,33 The use of these drugs may have reduced both mortality and BNP over the 7 years of the study thereby potentially obscuring an even tighter association between BNP and mortality during the study period.…”

Section: Discussionmentioning

confidence: 99%

Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide

McKie¹,

Rodeheffer²,

Cataliotti³

et al. 2006

Hypertension

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141

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Abstract-Recent studies report that, in the absence of heart failure and renal failure, plasma B-type natriuretic peptide (BNP) has prognostic value for mortality. We sought to confirm and extend these previous studies to assess BNP, measured by 3 distinct assays, as a biomarker for mortality in a strategy to enhance efforts at primary prevention and to better understand the clinical phenotype of such subjects at risk. We used a community-based cohort of 2042 subjects from Olmsted County, Minn, and individuals with heart or renal failure were excluded. BNP was assessed using 3 assays including Biosite and Shionogi for mature, biologically active BNP and the Roche assay for apparently nonbiologically active amino-terminal pro-BNP (NT-proBNP). Thorough echocardiographic and clinical data were recorded for all of the participants. Median follow-up for mortality was 5.6 years. BNP by all 3 of the assays was predictive of mortality. NT-proBNP and Biosite assays remained significant even after adjustment for traditional clinical risk factors and echocardiographic abnormalities including left ventricular hypertrophy and diastolic dysfunction. Echocardiography documented widespread structural changes in those with increasing BNP levels yet below levels observed in heart failure. We report in a large, well-characterized community-based cohort, free of heart failure, the first study to compare 3 distinct BNP assays as biomarkers for mortality in the same cohort. Our findings confirm the potential use of NT-proBNP and BNP biomarkers for future events and underscore that these peptides may also serve as biomarkers for underlying cardiac remodeling secondary to diverse cardiovascular disease entities. Key Words: natriuretic peptide Ⅲ hypertrophy T he cardiac hormone B-type natriuretic peptide (BNP) has proved useful in the diagnosis of human heart failure (HF). 1-3 Recently, studies have provided compelling data that plasma BNP, even in the absence of HF, has prognostic value for future cardiovascular events. 4 -6 Specifically, Wang et al 4 from the Framingham Heart Study reported in a prospective investigation in the general population without HF or renal failure that with each 1 SD increase in log BNP levels, there were significant increases in the risk of death, HF, atrial fibrillation, stroke or TIA, and first cardiovascular event over 5.2 mean years of follow-up. The reported plasma values associated with increased risk were well below the HF diagnosis threshold of 100 pg/mL. These important results suggest that, in the absence of HF, before the development of overt cardiac disease, modest elevations in plasma BNP are meaningful. Whereas this previous study provided significant information regarding the prognostic implications of BNP values below those seen in HF, the Framingham Heart Study 4 and others 5,7 have asked for validation of these findings in additional large, community-based studies.The current study was, therefore, designed to validate, as well as extend these recent seminal reports. We used the Prevalence ...

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Section: Discussionmentioning

confidence: 99%

Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide

McKie¹,

Rodeheffer²,

Cataliotti³

et al. 2006

Hypertension

Self Cite

141

View full text Add to dashboard Cite

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“…Prospective observational studies have shown that decreases ≥30% in this surrogate marker of efficacy correlate with improved prognosis 31-33 and treatment of patients with CHF tends to lead to a decrease in natriuretic peptide levels over time. [34][35][36][37][38][39][40][41] A potential confounding factor is that NT-proBNP levels may be increased in patients with atrial fibrillation and CHF compared with those without atrial fibrillation. However, atrial fibrillation was accounted for when performing an analysis of covariance for the absolute change in NT-proBNP levels.…”

Section: Study Limitationsmentioning

confidence: 99%

A Randomized Controlled Study of Finerenone vs. Eplerenone in Japanese Patients With Worsening Chronic Heart Failure and Diabetes and/or Chronic Kidney Disease

Sato

Ajioka

Yamada

et al. 2016

Circ J

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on behalf of the ARTS-HF Japan study group Background: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, was evaluated in Japanese patients with heart failure (HF) with reduced ejection fraction and chronic kidney disease and/or diabetes mellitus.Methods and Results: ARTS-HF Japan was a randomized, double-blind, phase 2b study. Patients (n=72) received oral, once-daily (o.d.) finerenone (2.5, 5, 7.5, 10 or 15 mg, up-titrated to 5, 10, 15, 20, or 20 mg, respectively, on day 30) or eplerenone (25 mg every other day, increased to 25 mg o.d. on day 30, and 50 mg on day 60) for 90 days. The primary endpoint was the proportion of individuals with a decrease of >30% in plasma NT-proBNP at day 90. Safety endpoints included the incidence of hyperkalemia. Decreases in NT-proBNP occurred in 23.1% of patients in the eplerenone group and 15.4%, 23.1%, 45.5%, 27.3% and 45.5% in the 2.5→5 mg, 5→10 mg, 7.5→15 mg, 10→20 mg and 15→20 mg finerenone groups, respectively (all P=NS). Mean changes in serum potassium levels were similar between groups. Conclusions:Because of the small sample size, limited conclusions can be drawn. Considering the results of ARTS-HF and that finerenone was well tolerated in Japanese patients in ARTS-HF Japan, the safety and efficacy of finerenone should be further explored in a large outcomes trial including Japanese patients. (Circ J 2016; 80: 1113 -1122

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“…In a proof-of-principle study Murdoch et al demonstrated the ability to drive plasma peptide concentrations down during escalation of vasodilator therapy (7 ). In the case of ␤ blockade the initial response is an increase in plasma B peptides followed weeks or months later by a decline when beneficial remodeling is established and ventricular transmural distending pressure gradients are ameliorated (8 ). A beneficial response to cardiac resynchronization therapy is reflected in declines in circulating BNP/NTproBNP (9 ).…”

confidence: 99%

Use of Natriuretic Peptides to Guide and Monitor Heart Failure Therapy

Richards

Troughton

2012

Clinical Chemistry

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BACKGROUND Plasma B-type cardiac natriuretic peptides reflect cardiac structure and function and have proven roles in assisting in the diagnosis of acute heart failure. They are independent prognostic indicators across the full spectrum of cardiovascular disease. Serial changes in plasma B-type cardiac natriuretic peptides parallel prognosis in chronic heart failure. Beneficial responses to medications and devices used in the treatment of heart failure are associated with decreases in plasma B-type peptide concentrations. This effect has led to the hypothesis that intensified treatment directed at reducing B-peptide concentrations may improve outcomes in heart failure. CONTENT The efficacy of serial measurements of plasma B-type peptides in guiding titration of therapy for chronic heart failure has been the subject of several randomized controlled trials reported in the peer-reviewed literature since 2000. These reports are summarized in this review. Trial design, characteristics of the heart-failure population studied, duration of follow-up, exact end points recorded, and target peptide concentrations pursued all differ somewhat between trials. In addition, in studies in which benefits were seen, the exact mechanisms mediating the improvements in outcome were unclear. However, an overall consistency is emerging that is supported by 2 metaanalyses. SUMMARY In aggregate the existing trial data suggest that adjustment of treatment in chronic heart failure according to serial B-type peptide measurements, used in conjunction with established clinical methods, is likely to reduce cardiac mortality and hospital admissions with heart failure, at least in patients with systolic heart failure who are younger than 75 years and relatively free of comorbidities.

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Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide levels in patients with congestive heart failure

Cited by 54 publications

References 28 publications

Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide

Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide

A Randomized Controlled Study of Finerenone vs. Eplerenone in Japanese Patients With Worsening Chronic Heart Failure and Diabetes and/or Chronic Kidney Disease

Use of Natriuretic Peptides to Guide and Monitor Heart Failure Therapy

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