College of Pharmacy, Western University of Health Sciences, Pomona, California 91766, USA.
J Card Fail. 2011 Mar;17(3):181-7. doi: 10.1016/j.cardfail.2010.10.005. Epub 2010 Dec 3.
Rises in serum creatinine and efficacy have been reported as dose-related effects of nesiritide and nitroglycerin in acute decompensated heart failure (ADHF). However, no study has evaluated the comparative safety, efficacy, and biomarkers of optimally dosed nesiritide versus nitroglycerin in ADHF.
Eighty-nine ADHF patients were prospectively randomized to receive either nesiritide (0.01 μg kg(-1) min(-1) ± bolus) or nitroglycerin (maximally tolerated doses by standard protocol). Blood urea nitrogen (BUN), and creatinine were obtained during 48 hours of intravenous infusion. B-Type natriuretic peptide (BNP) and N-terminal (NT) proBNP concentrations were measured during hospitalization. There were no significant differences in BUN, serum creatinine, creatinine clearance, or hospitalization and mortality. Although concentrations of BNP and NT-proBNP were significantly decreased over time, the comparative reductions between the 2 vasodilators were similar.
Nesiritide and nitroglycerin produce similar hemodynamic effects, do not worsen markers of renal function, and produce significant, yet similar, reductions in neurohormones over time. Both nitroglycerin at maximally titrated doses and nesiritide at standard doses are safe and effective in patients with ADHF who require vasodilator therapy.
奈西立肽和硝酸甘油在急性失代偿性心力衰竭（ADHF）中与剂量相关，会引起血清肌酐升高和疗效改善。然而，尚无研究评估最佳剂量的奈西立肽与硝酸甘油在 ADHF 中的安全性、疗效和生物标志物。
89 例 ADHF 患者前瞻性随机分为奈西立肽（0.01μg/kg·min-1±推注）或硝酸甘油（按标准方案给予最大耐受剂量）组。静脉输注 48 小时内采集血尿素氮（BUN）和肌酐。住院期间测量 B 型利钠肽（BNP）和 N 末端（NT）proBNP 浓度。BUN、血清肌酐、肌酐清除率或住院时间和死亡率无显著差异。尽管 BNP 和 NT-proBNP 浓度随时间显著降低，但 2 种血管扩张剂的降低幅度相似。
奈西立肽和硝酸甘油产生相似的血液动力学效应，不会加重肾功能标志物的异常，并且随时间推移显著降低神经激素水平，但降低幅度相似。硝酸甘油在最大滴定剂量和奈西立肽在标准剂量下均安全有效，适用于需要血管扩张剂治疗的 ADHF 患者。
