The effects of medications on circulating levels of cardiac natriuretic peptides

Figures & data

Table I. Studies reporting a stimulatory effect of beta‐blocker drugs on circulating levels of cardiac natriuretic peptides in healthy volunteers, or patients with coronary heart disease or hypertension.

Author (reference)	Subjects	n	Beta‐blocker	Duration	Change in:
					ANP	NT‐proANP	BNP	NT‐proBNP
Nakaoka 23	EH	31	any	‘Long term’	↑×2 ^a
	EH	10	atenolol	4 weeks	↑×2 ^b
Thamsborg 24	Normals	6	atenolol	2 hours	↑ R&E ^c
Bouissou 25	Normals	9	propranolol
			pindolol	3 days	↑ R&E ^c
Donckier 26	Normals	6	propranolol	4 days	↑ E 130% ^c
Deray 27	Normals	9	tertatolol
			atenolol	single dose	↑ E×2 ^c
Tsai 28	Normals	6	propranolol	3 days	↑ R&E ^c
Colantonio 29	EH	10	atenolol	7 days	↑ ^b
Kohno 30	EH	7	atenolol		↑ NS ^c
		9	carteolol	1 hour	↑ ^c
Berlin 31	Normals	8	tertatolol	single dose	↑ E 35% ^c
Riley 32	Angina	16	epanolol	4 weeks	↑ E×2 ^c
Elijovich 33	EH	9	atenolol	10 weeks	↑ ^b
Luchner 34	EH	80	various	chronic	↑ ^a		↑ ^a
Papadopoulos 35	EH	23	celiprolol	30 days	↑ 190% ^b
Deary 36	EH	30	bisoprolol	6 weeks			↑×3 ^c
van den Meiracker 37	EH	24	bisoprolol	8 weeks	↑ 93% ^c	↑ 83% ^c	↑ 148% ^c
Marie 38	CAD	55	various	chronic	↑ E ^a		↑ E ^a
Olsen 39	EH	91	atenolol	4 years		↑ ^b		↑ ^b

EH = essential hypertension; CAD = coronary artery disease; R = resting; E = exercise; NS = not statistically significant.

^a Comparator group was untreated controls.

^b Compared with baseline levels, before beta‐blockade, within the same group.

^c Comparison is within the same subjects but without beta‐blocker administration (usually during placebo administration).

Figure 1. Plasma cardiac natriuretic peptide levels(mean±SEM) in 16 patients with congestive heart failure before (pre‐treatment) and 6 weeks after the introduction of metoprolol (closed symbols) or unchanged treatment (open symbols). From reference 5 with permission.

Figure 2. Mean plasma levels of NT‐proBNP (N‐BNP) in 49 patients with chronic heart failure given either metoprolol (Meto) or carvedilol (Carv) for 52 weeks. From reference 60 with permission.

Figure 3. Percentage change from baseline(taken as 100%) in mean plasma levels of ANP with the introduction of beta‐blocker therapy in patients with heart failure according to duration of treatment with the beta‐blocker (range 5 hrs–20 months). Data were taken from all available studies reported in the literature. Although the percentage change in ANP appeared to relate to duration of therapy, the log‐linear association did not reach conventional statistical significance (P = 0.061).

Figure 4. Impact on plasma levels of NT‐proBNP of initiating treatment with carvedilol (BB) before perindopril (ACEI) versus perindopril before carvedilol in patients with newly diagnosed heart failure (n = 38 and 40, respectively). In each case, the alternative drug was added after 6 months of treatment with the initial drug. *P<0.0005 versus baseline data; †P<0.01 versus change from baseline in the ACEI‐first group. From reference 61 with permission.

Figure 5. Plasma levels of norepinephrine and natriuretic peptides before and after 4 months of treatment with metoprolol in 14 patients on chronic haemodialysis. Changes in norepinephrine were not statistically significant. From reference66 with permission.

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