Effect of nesiritide in combination with standard therapy on serum concentrations of natriuretic peptides in patients admitted for decompensated congestive heart failure

• Published in: The American heart journal Vol. 150; no. 3; pp. 471 - 477
• Main Authors: Fitzgerald, Robert L., Cremo, Rosemary, Gardetto, Nancy, Chiu, Albert, Clopton, Paul, Bhalla, Vikas, Maisel, Alan S.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2005; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Amino acids; Biological and medical sciences; Cardiology. Vascular system; Drug therapy; Heart; Heart failure; Heart Failure - blood; Heart Failure - drug therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization; Humans; Intravenous therapy; Male; Medical sciences; Middle Aged; Mortality; Natriuretic Agents - therapeutic use; Natriuretic Peptide, Brain - blood; Natriuretic Peptide, Brain - therapeutic use; Peptide Fragments - blood; Peptides; Prospective Studies; Smooth muscle; Human; Heart failure; Drug combination; Peptides; Nesiritide; Cardiovascular disease; Standard; Concentration; Phlebology; Standards; Heart disease; Serum; Combined treatment; Circulatory system; Cardiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2004.11.021

The objective of this study is to determine the effect of nesiritide (human recombinant BNP [hBNP]) in combination with standard therapy on the concentrations of B-type natriuretic peptide (BNP) and N-terminal probrain natriuretic peptide (NT-proBNP). B-type natriuretic peptide is synthesized in cardiac ventricles as a prohormone (108 amino acids) and when released into peripheral circulation is cleaved into the active hormone BNP (amino acids 77-108) and an inactive amino terminal fragment NT-proBNP (amino acids 1-76). Three groups of patients with acutely decompensated congestive heart failure (CHF) received nesiritide for 24, 36, or 48 hours (n = 5, 7, and 7, respectively) in addition to standard therapy. Serial blood samples were collected. B-type natriuretic peptide and NT-proBNP were measured. To correct for positive skew, natriuretic peptide concentrations were log transformed. The mean baseline (prenesiritide), 6-, 12-, and 24-hour infusion, and 6-, 12-, and 24-hour postinfusion concentrations of BNP were 1000, 2300, 2200, 1700, 580, 640, and 740 pg/mL, respectively (n = 19). The 6- and 12-hour postinfusion concentrations of BNP were significantly lower (<0.05) than baseline. The mean baseline, 60-, 120-, and 24-hour infusion, and 6-, 12-, and 24-hour postinfusion concentrations of NT-proBNP were 6600, 6500, 5800, 4300, 4100, 4300, and 5100 pg/mL, respectively (n = 19). From the time point 24 hours after initiation of therapy through 12 hours postinfusion, the mean NT-proBNP concentration was significantly (<0.05) lower than baseline. Nesiritide, in combination with standard therapy, significantly lowered the endogenous concentrations of natriuretic peptides during infusion and after dosing was completed.