Synthetic human
brain natriuretic peptide (
sBNP) is a
polypeptide with the same amino acid sequence as the naturally occurring
hormone. Preclinical studies have demonstrated that BNP has potent hemodynamic,
diuretic, and
natriuretic effects that might be beneficial in treating patients with
heart failure. This study was a randomized, double-blind, placebo-controlled, ascending-dose trial of
sBNP administered as a single intravenous bolus in 27
heart failure patients. Six groups of patients received sequentially increasing doses of
sBNP (0.3, 1, 3, 10, 15, and 20 micrograms/kg, respectively) as a single
intravenous injection, and hemodynamics were assessed by pulmonary artery monitoring
catheter. The 10 and 15 micrograms/kg doses of
sBNP resulted in significant reductions in pulmonary capillary wedge pressure (-73%, p < 0.001), mean pulmonary artery pressure (-41%, p < 0.001), mean arterial blood pressure (-28%, p = 0.001), and systemic vascular resistance (-53%, p = 0.004). Significant increases occurred in cardiac index (68%, p < 0.001) and stroke volume index (72%, p < 0.001). The magnitude and duration of hemodynamic changes were dose dependent. There were no adverse effects.
sBNP injected as a single intravenous bolus in
heart failure patients improves hemodynamics in a dose-related fashion. Further clinical investigations to determine the use of
sBNP in decompensated
heart failure are clearly warranted.