A study of the sequential treatment of acute heart failure with sacubitril/valsartan by recombinant human brain natriuretic peptide: A randomized controlled trial.

Abstract

ABSTRACT:

This study aimed to investigate the effects of the basic treatment for heart failure and sequential treatment with rh-brain natriuretic peptide (rhBNP) alone or the combination of rhBNP and sacubitril/valsartan. Cardiac structure, pulmonary artery pressure, inflammation and oxidative stress in patients with acute heart failure were evaluated.Three hundred patients with acute heart failure were included. According to the random number table method, the patients were divided into 3 groups of 100 patients per group: the standard treatment group (treated with an angiotensin-converting enzyme inhibitor, β receptor blocker, and corticosteroid antagonist), rhBNP group (basic treatment combined with rhBNP) and sequential treatment group (basic treatment for heart failure combined with rhBNP followed by sacubitril/valsartan). The changes in NT-probrain natriuretic peptide (BNP) levels, cardiac troponin T (cTnT) levels, cardiac structure, pulmonary artery pressure, and the levels inflammatory factors and oxidative stress factors were compared among the 3 groups at 1, 4, 12, and 36 weeks after treatment.The sequential treatment group displayed superior outcomes than the standard treatment group and the rhBNP group in terms of left atrium diameter, left ventricular end diastolic volume, left ventricular ejection fraction, pulmonary artery pressure, NT-proBNP levels, and cTnT levels, which respond to damage to the heart structure and myocardium. This result may be related to the decreased levels of inflammatory factors and the correction of oxidative stress imbalance.Sacubitril/valsartan significantly reduce the serum levels of inflammatory factors in patients with acute heart failure while decreasing the levels of oxidizing factors and increasing the levels of antioxidant factors. These changes may be one of the explanations for the better cardiac structure and better pulmonary artery pressure observed in the sequential treatment group.

• Authors: Zhihua Pang, Chang Pan, Zhuhua Yao, Ying Ren, Liuyang Tian, Jian Cui, Ximei Liu, Lijun Zhang, Ying Chen
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 16 Pg. e25621 (Apr 23 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 33879733 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Adrenergic beta-Antagonists
• Aminobutyrates
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Biomarkers
• Biphenyl Compounds
• Drug Combinations
• Hormone Antagonists
• Inflammation Mediators
• TNNT2 protein, human
• Tetrazoles
• Troponin T
• Natriuretic Peptide, Brain
• Valsartan
• sacubitril and valsartan sodium hydrate drug combination

Topics

• Acute Disease
• Adrenergic beta-Antagonists (administration & dosage)
• Aged
• Aminobutyrates (administration & dosage)
• Angiotensin Receptor Antagonists (administration & dosage)
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Arterial Pressure (drug effects)
• Biomarkers (blood)
• Biphenyl Compounds
• Drug Combinations
• Drug Therapy, Combination
• Female
• Heart Failure (drug therapy, pathology, physiopathology)
• Hormone Antagonists (administration & dosage)
• Humans
• Inflammation
• Inflammation Mediators (blood)
• Male
• Middle Aged
• Myocardium (pathology)
• Natriuretic Peptide, Brain (administration & dosage)
• Oxidative Stress (drug effects)
• Pulmonary Artery (physiopathology)
• Stroke Volume (drug effects)
• Tetrazoles (administration & dosage)
• Treatment Outcome
• Troponin T (blood)
• Valsartan