Nesiritide, a recombinant human
B-type natriuretic peptide, is the first in a new drug class for the treatment of decompensated
heart failure. The drug binds to receptors in the vasculature, kidney, adrenal gland, and brain, and overcomes resistance to endogenous BNP present in patients with CHF.
Nesiritide administration leads to a rapid and balanced vasodilatory effect, which results in a significant decrease in right and left ventricular filling pressures and systemic vascular resistance and at the same time in an increase in stroke volume and cardiac output without a change in heart rate. These early hemodynamic changes result in a rapid improvement in symptoms of
heart failure. In addition,
nesiritide lowers
aldosterone,
catecholamines, and
endothelin-1 levels and its effect on the kidney leads to an increased natriuresis and diuresis without effect on serum
potassium or renal function. Prior to its approval for clinical use,
nesiritide was studied in 10 different clinical trials involving 941 patients with moderate and severe CHF, including elderly patients, patients with both systolic and diastolic dysfunction, and patients with arrhythmias,
renal insufficiency, and acute ischemic syndrome. In comparative studies with available vasoactive
therapies frequently used for treatment of patients with decompensated
heart failure,
nesiritide was proven comparable in efficacy to inotropic drugs such as
dobutamine, but superior in safety. In a recent study,
nesiritide was found to be more effective and better tolerated than the
vasodilator,
nitroglycerin. The most common side effects expected with the use of
nesiritide are
headaches and decrease in blood pressure. At the recommended dose of
nesiritide,
headache was reported during the first 24 hours of treatment in 8% of patients and symptomatic
hypotension in 4% of patients, compared to 20% and 5% in
nitroglycerin-treated patients.