Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes

Abstract

While recent guidelines for the treatment of acute heart failure syndromes (AHFS) recommend pharmacotherapy with vasodilators in patients without excessively low blood pressure (BP), few reports have compared the relative efficiency of vasodilators on hemodynamics in AHFS patients. The present study aimed to assess the differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with AHFS. Thirty-eight consecutive patients were assigned to receive 48-h continuous infusion of carperitide (n = 19; 0.0125-0.05 μg/kg/min) or nicorandil (n = 19; 0.05-0.2 mg/kg/h). Hemodynamic parameters were estimated at baseline, and 2, 24, and 48 h after drug administration using echocardiography. After 48 h of infusion, systolic BP was significantly more decreased in the carperitide group compared with that in the nicorandil group (22.1 ± 20.0 % vs 5.3 ± 10.4 %, P = 0.003). While both carperitide and nicorandil significantly improved hemodynamic parameters, improvement of estimated pulmonary capillary wedge pressure was greater in the carperitide group (38.2 ± 14.5 % vs 26.5 ± 18.3 %, P = 0.036), and improvement of estimated cardiac output was superior in the nicorandil group (52.1 ± 33.5 % vs 11.4 ± 36.9 %, P = 0.001). Urine output for 48 h was greater in the carperitide group, but not to a statistically significant degree (4203 ± 1542 vs 3627 ± 1074 ml, P = 0.189). Carperitide and nicorandil were differentially effective in improving hemodynamics in AHFS patients. This knowledge may enable physicians in emergency wards to treat and manage patients with AHFS more effectively and safely.

Effect of Nicorandil in Patients with Heart Failure: A Systematic Review and Meta‐Analysis

“…In Akihiro Shirakabe and Takahisa Yamada studies, some patients were included in both the controlled and uncontrolled study analyses, but they were only included once in any given analysis, and so, there was no overlap in patients included in our meta‐analyses. Some studies either they were designed with an inappropriate control or only data about the nicorandil group could be extracted, although they were RCT, we still treated them as observational studies without a control group.…”

“…Table summarizes the design and methods of the included studies. There were five randomized controlled trials (n = 271), three observational study with a control group (n = 587) (i.e., controlled studies), and 12 observational studies without a control group (n = 391) (i.e., uncontrolled studies). Table summarizes the baseline characteristics of the included study subjects.…”

Association between NPPA promoter methylation and hypertension: results from Gusu cohort and replication in an independent sample

“…As one of the main components of the natriuretic peptides system, ANP has been widely considered a potential drug candidate for the cardiovascular system due to its biological functions of natriuresis, diuresis, vasorelaxation, and inhibition of renin and aldosterone secretion [ 32 ]. The recombinant ANP carperitide has been used in clinical practice for the management of acute decompensated heart failure [ 23 , 24 ] but could cause some unfavorable effects, e.g., severe hypotension [ 24 – 26 ] and in-hospital death [ 27 – 29 ]. A better understanding of the molecular mechanisms underlying the association between ANP and hypertension may help its drug development and improvement.…”

Atrial natriuretic peptide and regulation of vascular function in hypertension and heart failure

“…Carperitide was approved for the treatment of Acute Heart Failure Syndrome (AHFS) in Japan in 1995 and it is currently a common drug used in patients with normotensive or hypertensive AHFS [81]. A comparison of hemodynamic responses to Carperitide and Nicorandil in hypertensive and normotensive AHFS patients showed a greater improvement of SBP and filling pressures with a better diuretic activity in Carperitidetreated group [82]. Short-term infusion therapy with Carperitide significantly decreased systolic and diastolic BP levels as compared to Olprinone [83].…”