Rosenberg Jens, Gustafsson Finn, Remme Willem J, Riegger Günter A J, Hildebrandt Per Rossen
Cardiology Department, Frederiksberg University Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Cardiovasc Drugs Ther. 2008 Aug;22(4):305-11. doi: 10.1007/s10557-008-6099-6. Epub 2008 Feb 29.
The long-term effect of beta-blockade on the plasma levels of natriuretic peptides BNP and its N-terminal counterpart, NT-proBNP, as risk markers in heart failure (HF) is obscure.
Stable systolic HF patients from the CARMEN study were divided in groups matching their randomised treatment allocation: Carvedilol, enalapril or carvedilol+enalapril. Changes in BNP and NT-proBNP from baseline to 6 months maintenance visit were evaluated in each treatment arm. Furthermore, the prognostic value of BNP and NT-proBNP during monotherapy with carvedilol was assessed with univariate Cox proportional hazards models using a combined endpoint of all cause mortality and cardiovascular hospitalisation.
NT-proBNP and BNP were significantly reduced after six months treatment with enalapril (NT-proBNP 1,303 to 857 pg/ml (P < 0.001), BNP 119 to 85 pg/ml (P < 0.001)) or carvedilol+enalapril (NT-proBNP 1,223 to 953 pg/ml (P = 0.003), BNP 117 to 93 pg/ml (P = 0.01)). In contrast, no change was observed in the carvedilol group (NT-proBNP 907 to 1,082 pg/ml (P = 0.06), BNP 114 to 130 pg/ml (P = 0.15). The prognostic value of NT-proBNP and BNP was maintained in the carvedilol group (NT-proBNP HR 1.018 95% CI (1.005-1.032), BNP 1.171 (1.088-1.260)).
Treatment of HF patients with carvedilol alone does not reduce levels of natriuretic peptides, but treatment with enalapril does. Both BNP and NT-proBNP predict death and hospitalisation in HF patients treated with carvedilol for six months. The clinical implication of our results is that NT-proBNP and BNP can be used as risk markers of death and cardiovascular hospitalisations in systolic HF patients receiving carvedilol without ACE inhibition.
β受体阻滞剂对利钠肽B型钠尿肽（BNP）及其N端前体（NT-proBNP）血浆水平的长期影响尚不明确，而BNP和NT-proBNP是心力衰竭（HF）的风险标志物。
来自CARMEN研究的稳定收缩性HF患者根据其随机治疗分配分组：卡维地洛组、依那普利组或卡维地洛+依那普利组。评估每个治疗组从基线到维持治疗6个月时BNP和NT-proBNP的变化。此外，使用全因死亡率和心血管住院的联合终点，通过单变量Cox比例风险模型评估卡维地洛单药治疗期间BNP和NT-proBNP的预后价值。
依那普利治疗6个月后，NT-proBNP和BNP显著降低（NT-proBNP从1303降至857 pg/ml（P<0.001），BNP从119降至85 pg/ml（P<0.001）），卡维地洛+依那普利组也有类似结果（NT-proBNP从1223降至953 pg/ml（P = 0.003），BNP从117降至93 pg/ml（P = 0.01））。相比之下，卡维地洛组未观察到变化（NT-proBNP从907升至1082 pg/ml（P = 0.06），BNP从114升至130 pg/ml（P = 0.15））。卡维地洛组中NT-proBNP和BNP的预后价值得以维持（NT-proBNP风险比1.018，95%置信区间（1.005 - 1.032），BNP 1.171（1.088 - 1.260））。
单独使用卡维地洛治疗HF患者不会降低利钠肽水平，但依那普利治疗可以。在接受卡维地洛治疗6个月的HF患者中，BNP和NT-proBNP均可预测死亡和住院情况。我们结果的临床意义在于，在未接受ACE抑制治疗的接受卡维地洛治疗的收缩性HF患者中，NT-proBNP和BNP可作为死亡和心血管住院的风险标志物。
