Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Effect of Valsartan on N-Terminal Pro-Brain Natriuretic Peptide in Patient With Stable Chronic Heart Failure: Comparison With Enalapril

  • Lee, Young-Soo (Department of Cardiology, Catholic University of Daegu) ;
  • Kim, Kee-Sik (Department of Cardiology, Catholic University of Daegu) ;
  • Lee, Jin-Bae (Department of Cardiology, Catholic University of Daegu) ;
  • Ryu, Jae-Kean (Department of Cardiology, Catholic University of Daegu) ;
  • Choi, Ji-Yong (Department of Cardiology, Catholic University of Daegu) ;
  • Kim, Byong-Kyu (Department of Cardiology, Catholic University of Daegu) ;
  • Chang, Sung-Gug (Department of Cardiology, Catholic University of Daegu) ;
  • Hur, Seung-Ho (Department of Cardiology, Keimyung University College of Medicine) ;
  • Lee, Bong-Ryeol (Department of Cardiology, Fatima General Hospital) ;
  • Jung, Byung-Chun (Department of Cardiology, Fatima General Hospital) ;
  • Hong, Geu-Ru (Department of Cardiology, Yeungnam University College of Medicine) ;
  • Kim, Byung-Soo (Department of Cardiology, DaeDong Hospital) ;
  • Park, Tae-Ho (Department of Cardiology, Dong-A University College of Medicine) ;
  • Kim, Young-Dae (Department of Cardiology, Dong-A University College of Medicine) ;
  • Kim, Tae-Ik (Department of Cardiology, Maryknoll Medical Center) ;
  • Kim, Dong-Soo (Department of Cardiology, Busan Paik Hospital)
  • Published : 2011.02.28
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Abstract

Background and Objectives: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have demonstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. Subjects and Methods: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. Results: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. Conclusion: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.

Keywords

References

  1. Harrap SB, Dominiczak AF, Fraser R, et al. Plasma angiotensin II, predisposition to hypertension, and left ventricular size in healthy yo-ung adults. Circulation 1996;93:1148-54. https://doi.org/10.1161/01.CIR.93.6.1148
  2. Kasama S, Toyama T, Kumakura H, et al. Spironolactone improves car-diac sympathetic nerve activity and symptoms in patients with conges-tive heart failure. J Nucl Med 2002;43:1279-85.
  3. Curtiss C, Cohn JN, Vrobel T, Franciosa JA. Role of the renin-angiotensin system in the systemic vasoconstriction of chronic congestive he-art failure. Circulation 1978;58:763-70. https://doi.org/10.1161/01.CIR.58.5.763
  4. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the cooperative north Sc-andinavian enalapril survival study (CONSENSUS). N Engl J Med 1987;316:1429-35. https://doi.org/10.1056/NEJM198706043162301
  5. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart fa-ilure. N Engl J Med 1991;325:293-302. https://doi.org/10.1056/NEJM199108013250501
  6. Cohn JN, Tognoni G, for the Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667-75. https://doi.org/10.1056/NEJMoa010713
  7. Koglin J, Pehlivanli S, Schwaiblmair M, Vogeser M, Cremer P, vonScheidt W. Role of brain natriuretic peptide in risk stratification of pa-tients with congestive heart failure. J Am Coll Cardiol 2001;38:1934-41. https://doi.org/10.1016/S0735-1097(01)01672-2
  8. Kim SH, Kim JS, Baek KK, et al. Role of NT-proBNP in evaluation of functional status in congestive heart failure. Korean Circ J 2004;34: 894-9.
  9. Yasue H, Yoshimura M, Sumida H, et al. Localization and mechanism of secretion of NT-pro-natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994;90:195-203. https://doi.org/10.1161/01.CIR.90.1.195
  10. Tsutamoto T, Wada A, Maeda K, et al. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in pa-tients with chronic symptomatic left ventricular dysfunction. Circulation 1997;96:509-16. https://doi.org/10.1161/01.CIR.96.2.509
  11. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European So-ciety of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63. https://doi.org/10.1016/j.echo.2005.10.005
  12. McDonagh TA, Robb SD, Murdoch DR, et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet 1998;351:9-13. https://doi.org/10.1016/S0140-6736(97)03034-1
  13. Tsutamoto T, Wada A, Maeda K, et al. Plasma brain natriuretic peptide level as a biochemical marker of morbidity and mortality in patients with asymptomatic or minimally symptomatic left ventricular dysfunction. Eur Heart J 1999;20:1799-807. https://doi.org/10.1053/euhj.1999.1746
  14. Chung IH, Yoo BS, Ryu HY, et al. The relationship between the early fol-low-up BNP level and congestive status or prognosis in acute heart failure. Korean Circ J 2006;36:200-7.
  15. Maeda K, Tsutamoto T, Wada A, et al. High levels of plasma brain na-triuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 2000;36: 1587-93. https://doi.org/10.1016/S0735-1097(00)00912-8
  16. Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000; 355:1126-30. https://doi.org/10.1016/S0140-6736(00)02060-2
  17. Nagaya N, Nishikimi T, Goto Y, et al. Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular re-modeling after acute myocardial infarction. Am Heart J 1998;135: 21-8. https://doi.org/10.1016/S0002-8703(98)70338-2
  18. Latini R, Masson S, Anand I, et al. Effects of valsartan on circulating brain natriuretic peptide and norepinephrine in symptomatic chronic heart failure: the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2002;106:2454-8. https://doi.org/10.1161/01.CIR.0000036747.68104.AC
  19. Kasama S, Toyama T, Hatori T, et al. Comparative effects of valsartan and enalapril on cardiac sympathetic nerve activity and plasma brain natriuretic peptide in patients with congestive heart failure. Heart 2006;92:625-30. https://doi.org/10.1136/hrt.2005.062463
  20. Kohno M, Horio T, Yokokawa K, et al. Brain natriuretic peptide as a cardiac hormone in essential hypertension. Am J Med 1992;92:29-34. https://doi.org/10.1016/0002-9343(92)90011-Y
  21. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998;339:321-8. https://doi.org/10.1056/NEJM199807303390507
  22. Tseng DS, Kwong J, Rezvani F, Coates AO. Angiotensin-converting enzyme-related cough among Chinese-Americans. Am J Med 2010; 123:183.e11-5. https://doi.org/10.1016/j.amjmed.2009.06.032
  23. Woo KS, Norris RM, Nicholls G. Racial differences in incidence of cough with angiotensin-converting enzyme inhibitors (a tale of two cities). Am J Cardiol 1995;75:967-8. https://doi.org/10.1016/S0002-9149(99)80703-6
  24. Nishizawa A. Angiotensin-converting enzyme inhibitor induced cough among Asians. Proc UCLA Health 2000;4:35-8.
  25. Yeo WW, Ramsay LE. Persistent dry cough with enalapril: incidence depends on the method used. J Hum Hypertens 1990;4:517-20.

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