BNP Better Than Guidelines at Guiding Heart Failure Treatment


ORLANDO, FLA. — Using serial plasma B-type natriuretic peptide levels to guide medical therapy in patients with systolic heart failure significantly reduces heart failure-related deaths and hospitalizations, Patrick Jourdain, M.D., said at the annual meeting of the American College of Cardiology.

Half of 220 patients in a 21-center French randomized trial received state-of-the-art, clinically guided medical therapy in accord with practice guidelines. The other half underwent monthly B-type natriuretic peptide (BNP) measurement for 3 months, then three times per year thereafter. The goal in the BNP group was to titrate doses of ACE inhibitors, β-blockers, and diuretics until plasma BNP dropped below 100 pg/mL.

During a median 15 months of follow-up there were three heart failure-related deaths in the BNP group and nine among the clinically managed patients. The primary composite end point in this unsponsored trial—heart failure-related death or hospitalization for heart failure—occurred in 25 patients in the BNP arm and 57 in the control group. This translates to a highly significant 54% reduction in relative risk when BNP was used to optimize medical management, noted Dr. Jourdain of Hôpital Rene Dubos, Pointoise, France.

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