Probrain Natriuretic Peptide for assessment of efficacy in heart failure treatment

Abstract

N-terminal probrain natriuretic peptide (NT-proBNP) is elevated in patients with heart failure. Numerous clinical trials have evaluated the efficacy of spironolactone in heart failure; however, no studies have directly examined the effects of spironolactone treatment on NT-proBNP level. This study investigated whether NT-proBNP levels decrease with daily spironolactone treatment. The study consisted of 117 adult patients with heart failure. All participants were divided into 3 groups, class I, class II, and class III, according to the New York Heart Association classification system. Patients were randomly assigned to receive spironolactone or were treated with another drug, other than spironolactone, as placebo. NT-proBNP plasma samples were taken at baseline and after 6 mo of treatment. A total of 62 patients were treated with daily spironolactone; 55 patients were followed with available treatment without spironolactone. The baseline demographic and laboratory parameters were similar for patients in all groups. At the end of 6 mo, spironolactone-treated patients had significantly lower NT-proBNP levels and significantly better ejection fractions than did patients in all New York Heart Association classes who were not treated with spironolactone. Results suggest that spironolactone decreases plasma NT-proBNP concentrations, and that the measurement of plasma NT-proBNP levels may be helpful in assessing therapeutic efficacy in patients who are treated for heart failure.

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

“…In the subset analysis of the EPHESUS, eplerenone had a similar adverse effect profile to placebo, with the exception of increased incidence of hyperkalemia (serum potassium Ն6.0 mmol/L; 1.7-fold) in hospitalized patient groups with a mean age of Ͼ65 years (59). Although not primarily designed as studies of elderly patients, several other studies that included patients who were a mean age of Ն65 years showed that use of spironolactone or eplerenone in this older population was tolerated and safe (55,60,61).…”

Natriuretic peptide-directed medical therapy: a systematic review

“…In 10 out of 18 trials, patients were seen by a specialist at a clinic (Anguita et al 2010;Berger et al 2010;Eurlings et al 2010;Januzzi et al 2011;Jourdain et al 2007;Lainchbury et al 2009;Murdoch et al 1999;Persson et al 2010;Schou et al 2013;Shah et al 2011;Troughton et al 2000). Most patients were randomized once heart Karlstrom et al 2011;Murdoch et al 1999;Ozkara et al 2007;Persson et al 2010;Schou et al 2013;Shah et al 2011;Stienen et al 2018;Troughton et al 2000). The remainder of the trials combined patients with preserved and reduced ejection fraction (Anguita et al 2010;Berger et al 2010;Carubelli et al 2016;Eurlings et al 2010;Lainchbury et al 2009;Maeder et al 2013;Pfisterer et al 2009).…”

“…Seventeen out of 18 studies reported mortality at trial completion (Anguita et al 2010;Beck-da-Silva et al 2005;Berger et al 2010;Carubelli et al 2016;Eurlings et al 2010;Felker et al 2017;Januzzi et al 2011;Jourdain et al 2007;Karlstrom et al 2011;Lainchbury et al 2009;Maeder et al 2013;Ozkara et al 2007;Persson et al 2010;Pfisterer et al 2009;Schou et al 2013;Shah et al 2011;Stienen et al 2018;Troughton et al 2000). After extracting the end of trial mortality data, it was deemed inappropriate to conduct a meta-analysis, as the duration of the trial follow up periods differed between the trials.…”

“…eight trials set individualized NP targets(Beck-da-Silva et al 2005;Eurlings et al 2010;Karlstrom et al 2011;Maeder et al 2013;Persson et al 2010;Pfisterer et al 2009;Schou et al 2013;Shah et al 2011;Stienen et al 2018), and one trial had no set NP target, but directed medical therapy to reduce the NP level(Ozkara et al 2007). The management of the standard care arms is shown in Additional file 1.Two trials were stopped early(Felker et al 2017;Januzzi et al 2011), Felker et.…”

Management of Diabetic Nephropathy in the Elderly: Special Considerations

“…The safety and tolerability of aliskiren in elderly patients has been evaluated in several trials [74][75][76][77][78]. These studies showed that aliskiren lowers BP effectively and is well tolerated, even in patients >75 years old.…”