Natriuretic peptides for the treatment of acute heart failure: a focus on nesiritide in recent clinical trials

Abstract

Nesiritide, a recombinant form of B-type natriuretic peptide, is a vasodilator and currently recommended as an additive therapy for patients with acute decompensated heart failure (ADHF) who have been optimized on loop diuretics. With hospitalizations for ADHF rising, appropriate selection of therapy becomes even more important to optimize efficacy and reduce adverse events. Nesiritide has many properties that antagonize the pathophysiologic processes of heart failure and has demonstrated a comparative benefit in previous reports; however, controversy still remains with respect to its efficacy and safety. Based on results from recent clinical trials, nesiritide has been shown to be safe at currently approved doses and strongly considered for the treatment of ADHF in patients who remain symptomatic despite optimal doses of intravenous loop divertics.

Keywords:

• acute decompensated heart failure
• ADHF
• BNP
• natriuretic peptides
• vasodilator

Financial & competing interests disclosure

SL Chow is a consultant for Amgen and Novartis. JH Patterson is a consultant for Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Acute decompensated heart failure continues to be a growing health problem, with cost and prevalence expected to increase over the next 20 years.

• Natriuretic peptides (NPs) have been shown to provide many beneficial properties in the setting of acute decompensated heart failure, including lusitropic, antifibrotic, diuretic, natriuretic, vasodilatory and neuromodulatory effects.

• Despite previously reports, nesiritide at currently approved doses does not increase mortality and is still a preferred option over inotropes.

• Hypotension can be reduced by judicious use of the intravenous bolus dose.

• Nesiritide does not worsen or improve renal function or diuresis at currently approved doses.

• Novel second-generation NPs are currently being explored to reduce worsening renal function and hypotension.

• Comparative clinical trials are needed to determine whether second-generation NPs offer an advantage over nesiritide.

Notes