BNP in hormone-guided treatment of heart failure

The pharmacotherapy of heart failure has become complex. Angiotensin-converting enzyme inhibitors (or angiotensin 11 receptor blockers), beta-blockers, spironolactone, diuretics and digoxin can be prescribed concurrently. Endothelin antagonists and combined inhibitors of converting enzyme and neutral endopeptidase are under investigation. Optimal dosing will become increasingly difficult to judge. Plasma brain natriuretic peptide (BNP) indicates the severity of left ventricular dysfunction. The C-terminal bioactive peptide and N-terminal BNP (N-BNP) circulate at concentrations related to cardiac status. We proposed that plasma levels of N-BNP would provide an index to guide drug treatment in established heart failure. Sixty-nine patients were randomized to treatment adjusted according to clinical criteria or plasma N-BNP Hormone-guided therapy resulted in fewer clinical end points than did clinical management. This encourages further exploration of hormone guidance of anti-heart failure therapy, which could be extended to patients with preserved ejection fraction, in addition to those with established systolic dysfunction.