Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations

Background There is currently no objective practical guide to intensity of drug treatment for individuals with heart failure. We hypothesised that pha rmacotherapy guided by plasma concentrations of the cardiac peptide aminote rminal brain natriuretic peptide (N-BNP) would produce a superior outcome t o empirical trial-based therapy dictated by clinical acumen. Methods 69 patients with impaired systolic function (left-ventricular eject ion fraction <40%) and symptomatic heart failure (New York Heart Associatio n class II-IV) were randomised to receive treatment guided by either plasma N-BNP concentration (BNP group) or standardised clinical assessment (clini cal group). Findings During follow-up (minimum 6-months, median 9.5 months), there were fewer total cardiovascular events (death, hospital admission, or heart fai lure decompensation) in the BNP group than in the clinical group (19 vs 54, p=0.02). At 6 months, 27% of patients in the BNP group and 53% in the clin ical group had experienced a first cardiovascular event (p=0.034). Changes in left-ventricular function, quality of life, renal function, and adverse events were similar in both groups. Interpretation N-BNP-guided treatment of heart failure reduced total cardio vascular events, and delayed time to first event compared with intensive cl inically guided treatment.