BACKGROUND: B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence. AIM: To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients. DESIGN OF STUDY: Screening study with single-arm intervention. SETTING: A total of 1918 patients with diabetes mellitus or ischaemic heart disease aged > or =65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration. METHOD: Eligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration of <36 pmol/l. RESULTS: Seven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (P<0.001). The most effective therapeutic step was a switch in beta-blocker to carvedilol or bisoprolol (P<0.001). CONCLUSION: About 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.
BACKGROUND:B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence. AIM: To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients. DESIGN OF STUDY: Screening study with single-arm intervention. SETTING: A total of 1918 patients with diabetes mellitus or ischaemic heart disease aged > or =65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration. METHOD: Eligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration of <36 pmol/l. RESULTS: Seven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (P<0.001). The most effective therapeutic step was a switch in beta-blocker to carvedilol or bisoprolol (P<0.001). CONCLUSION: About 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.
Authors: Alan S Maisel; Padma Krishnaswamy; Richard M Nowak; James McCord; Judd E Hollander; Philippe Duc; Torbjørn Omland; Alan B Storrow; William T Abraham; Alan H B Wu; Paul Clopton; Philippe G Steg; Arne Westheim; Catherine Wold Knudsen; Alberto Perez; Radmila Kazanegra; Howard C Herrmann; Peter A McCullough Journal: N Engl J Med Date: 2002-07-18 Impact factor: 91.245
Authors: Alan H B Wu; Milton Packer; Andrew Smith; Rachel Bijou; Daniel Fink; Johannes Mair; Lars Wallentin; Nina Johnston; Carolyn S Feldcamp; Doris M Haverstick; Charaf E Ahnadi; Andrew Grant; Normand Despres; Barry Bluestein; Farooq Ghani Journal: Clin Chem Date: 2004-03-09 Impact factor: 8.327
Authors: Christian Mueller; André Scholer; Kirsten Laule-Kilian; Benedict Martina; Christian Schindler; Peter Buser; Matthias Pfisterer; André P Perruchoud Journal: N Engl J Med Date: 2004-02-12 Impact factor: 91.245
Authors: M R Cowie; P Jourdain; A Maisel; U Dahlstrom; F Follath; R Isnard; A Luchner; T McDonagh; J Mair; M Nieminen; G Francis Journal: Eur Heart J Date: 2003-10 Impact factor: 29.983