Korean Circ J.  2011 Feb;41(2):61-67. 10.4070/kcj.2011.41.2.61.

Effect of Valsartan on N-Terminal Pro-Brain Natriuretic Peptide in Patient With Stable Chronic Heart Failure: Comparison With Enalapril

• Lee YS
• Kim KS
• Lee JB
• Ryu JK
• Choi JY
• Kim BK
• Chang SG
• Hur SH
• Lee BR
• Jung BC
• Hong GR
• Kim BS
• Park TH
• Kim YD
• Kim TI
• Kim DS

• KMID: 2225137
• DOI: http://doi.org/10.4070/kcj.2011.41.2.61

Abstract

BACKGROUND AND OBJECTIVES
The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker.
SUBJECTS AND METHODS
This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril.
RESULTS
The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups.
CONCLUSION
Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.

Keyword

Brain natriuretic peptide; Angiotensin-converting enzyme inhibitors; Angiotensin receptor blocker; Congestive heart failure

MeSH Terms

Angiotensin-Converting Enzyme Inhibitors
Angiotensins
C-Reactive Protein
Enalapril
Heart
Heart Failure
Humans
Natriuretic Peptide, Brain
Peptidyl-Dipeptidase A
Plasma
Prospective Studies
Renin-Angiotensin System
Stroke Volume
Tetrazoles
Valine
Valsartan
Angiotensin-Converting Enzyme Inhibitors
Angiotensins
C-Reactive Protein
Enalapril
Natriuretic Peptide, Brain
Peptidyl-Dipeptidase A
Tetrazoles
Valine

Figure

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  Fig. 1 Study design. TTE: transthoracic echocardiography, NT-pro-BNP: N-terminal pro-brain natriuretic peptide, hs-CRP: high sensitive C-reactive protein.

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  Fig. 2 Changes in NYHA functional class during treatment in the two groups. NYHA: New York Heart Association.

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  Fig. 3 Change of NT-pro-BNP and high sensitive C-reactive protein before and after treatment. NT-pro-BNP: N-terminal pro-brain natriuretic peptide, hs-CRP: high sensitive C-reactive protein.

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  Fig. 4 Change of NT-pro-BNP according to change of left ventricular ejection faction (LVEF) and LV end diastolic dimension (LVEDD). NT-pro-BNP: N-terminal pro-brain natriuretic peptide, hs-CRP: high sensitive C-reactive protein.

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