Earlier studies showed that this peptide released by the heart muscle in response to stress lowers blood pressure and has diuretic properties, with levels increased in patients with heart failure. Hence the interest in this peptide as a marker for the exclusion or presence and severity of heart failure.
Now, a randomised trial reported in JAMA suggests that, while using BNP as a marker to guide therapy is not associated with any improvement in all-cause outcome over conventional symptom-guided therapy, there is indeed a benefit in hospital-free survival in heart failure patients under the age of 75.1
The study (Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure [TIME-CHF]) was performed in 499 patients age 60 years or older hospitalised for heart failure within the past year and with N-terminal BNP levels at least twice the upper limit of normal. The subjects were randomised to receive treatment to reduce symptoms (symptom-guided therapy) or intensive treatment to reach a BNP level of no more than twice the upper limit of normal and reduce symptoms (BNP–guided therapy). The study population was then prospectively stratified into two age groups, under and over 75 years.
After a follow-up of 18 months, the BNP-guided strategy and symptom-guided strategies had similar outcomes with respect to all-cause hospitalisation (41% vs 40%) and survival. However, survival without hospitalisation for heart failure was significantly improved with BNP–guided therapy (72% vs. 62%). This benefit was not apparent in patients over the age of 75.
Thus, the study authors suggest that “persistence in intensifying medical therapy seems to be the key for an optimal clinical outcome in patients aged 60 to 74 years, whereas it may not be beneficial to push doses to the limits in patients aged 75 years or older”.
Commenting on the study on behalf of the European Society of Cardiology, Professor Kenneth Dickstein from Stavanger University Hospital in Norway emphasises the study’s difference in outcome between the under and over-75s. “The older people in this study did not do as well as the younger and did not respond as well to therapy,” he says. “So we still need trials properly powered to show the effect of BNP measurement as a marker in elderly patients who more closely reflect our everyday heart failure populations today. So, while we saw a benefit of intensive therapy guided by BNP levels in younger patients in this study, we didn’t see it in the over-75s, who generally had more advanced disease, co-morbidity and higher BNP levels.”
The study also showed that continual monitoring of BNP levels (performed at 1, 3, 6, 12 and 18 months in the BNP group) as a guide to treatment was not associated with any improvement in outcome: “A baseline measurement of BNP may be enough to initiate effective therapy,” says Professor Dickstein. “Serial measurements do not appear to have added value.”
ESC Press Office | alfa
Cnidarians remotely control bacteria
21.09.2017 | Christian-Albrechts-Universität zu Kiel
Immune cells may heal bleeding brain after strokes
21.09.2017 | NIH/National Institute of Neurological Disorders and Stroke
Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.
The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...
Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...
Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!
When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...
For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.
Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...
MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.
MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...
19.09.2017 | Event News
12.09.2017 | Event News
06.09.2017 | Event News
21.09.2017 | Physics and Astronomy
21.09.2017 | Life Sciences
21.09.2017 | Health and Medicine