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
Researchers develop eco-friendly, 4-in-1 catalyst
25.04.2017 | Brown University
Transfecting cells gently – the LZH presents a GNOME prototype at the Labvolution 2017
25.04.2017 | Laser Zentrum Hannover e.V.
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
25.04.2017 | Physics and Astronomy
25.04.2017 | Materials Sciences
25.04.2017 | Life Sciences