natriuretic-peptide--brain and Hypotension

Cardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and multifactorial causes, and varied hemodynamic parameters. Despite advances in interventions, mortality in patients with cardiogenic shock remains high. Emergency clinicians must be ready to recognize and start appropriate therapy for cardiogenic shock early.. This review will discuss the clinical evaluation and diagnosis of cardiogenic shock in the emergency department with a focus on the emergency clinician.. The most common cause of cardiogenic shock is a myocardial infarction, though many causes exist. It is classically diagnosed by invasive hemodynamic measures, but the diagnosis can be made in the emergency department by clinical evaluation, diagnostic studies, and ultrasound. Early recognition and stabilization improve morbidity and mortality. This review will focus on identification of cardiogenic shock through clinical examination, laboratory studies, and point-of-care ultrasound.. The emergency clinician should use the clinical examination, laboratory studies, electrocardiogram, and point-of-care ultrasound to aid in the identification of cardiogenic shock. Cardiogenic shock has the potential for significant morbidity and mortality if not recognized early.

Topics: Acidosis, Lactic; Bradycardia; Confusion; Early Diagnosis; Echocardiography; Edema; Electrocardiography; Emergency Service, Hospital; Heart Failure; Heart Murmurs; Humans; Hypotension; Kidney Function Tests; Lactic Acid; Liver Function Tests; Multiple Organ Failure; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Physical Examination; Point-of-Care Systems; Pulmonary Edema; Shock, Cardiogenic; Tachycardia; Troponin

Nesiritide is a recombinant form of human B-type natriuretic peptide, a naturally occurring endogenous hormone released by cardiac ventricles in response to an increase in ventricular wall stress. Its use in the treatment of acute decompensated heart failure (ADHF) has been evaluated in a series of randomised controlled clinical trials. It is currently approved in the US for the treatment of ADHF. Nesiritide induces a balanced vasodilation and an indirect increase in cardiac output, but has no actual inotropic effects and exerts a neutral effect on heart rate. In addition, it inhibits adverse neurohormonal activation and, in some individuals, promotes natriuresis and diuresis. In adults with ADHF, nesiritide reduces pulmonary capillary wedge pressure, right atrial pressure and systemic vascular resistance; decreases symptoms of heart failure; and enhances global clinical status. Important questions regarding the risks of nesiritide therapy have recently been raised, and resolution of the safety of nesiritide is a process that remains in evolution. The most frequently reported adverse effect is dose-related hypotension. In addition, nesiritide may cause an acute increase in serum creatinine concentration. This increase seems to be a haemodynamic response to a combination of volume depletion, vasodilation and neurohormonal inhibition. Nesiritide-induced changes in renal function have not been definitively shown to negatively affect mortality. The effect of nesiritide on all-cause mortality is currently unresolved. Recent meta-analyses of existing databases have raised concerns regarding adverse effects of the drug on 30-day mortality. However, reviews of large, observational, registry databases do not suggest an adverse inpatient mortality effect compared with other vasodilator therapies. Further resolution of the mortality question awaits completion of pending randomised controlled clinical trials. When used for approved indications and according to recommended dosage and administration regimens, nesiritide represents a reasonable treatment adjunct for ADHF.

Topics: Acute Disease; Arrhythmias, Cardiac; Heart Failure; Hemodynamics; Humans; Hypotension; Natriuretic Agents; Natriuretic Peptide, Brain; Renal Insufficiency; Risk Assessment

Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial.. The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization.. Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95).. In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.

Topics: Aged; Biomarkers; Blood Glucose; Blood Pressure; Female; Glucose; Glycated Hemoglobin; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Troponin T

To evaluate the effectiveness and safety of intravenous nicorandil application in patients with acute heart failure (AHF) with low baseline blood pressure (systolic blood pressure <110 mmHg).. This prospective, controlled, single-centre study randomised 147 patients with AHF with low baseline blood pressure (including both emergent admission and newly developed low blood pressure while in hospital) to one of the following two groups: (1) control group (conventional diuretics, positive inotropic agents, and related therapy according to the guidelines); and (2) intervention group (intravenous [IV] nicorandil application plus routine care). Dyspnoea severity, the ratio of E to e' (E/e'), the incidence of side effects and adverse events, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction (LVEF; left ventricular systolic function) before discharge, average length of hospitalisation, LVEF and soluble suppression of tumorigenicity-2 (sST2) at 3 months after discharge, incidence of major adverse cardiac and cerebrovascular events (MACCE) and readmission rate within 3 months were recorded and compared between the two groups.. Compared to the control group, nicorandil relieved dyspnoea effectively and improved E/e' significantly; the level of NT-proBNP was lower, LVEF was higher before discharge, and average length of hospital stay was shorter in the intervention group. After 3 months, the LVEF was higher, sST2 was lower, and the readmission rate was lower in the intervention group; there was no statistically significant difference in MACCE.. Patients with AHF with low baseline blood pressure could benefit from IV nicorandil application in the urgent phase, but the long-term profits remained to be confirmed.

Topics: Biomarkers; Blood Pressure; Heart Failure; Humans; Hypotension; Natriuretic Peptide, Brain; Nicorandil; Peptide Fragments; Prospective Studies; Stroke Volume; Ventricular Function, Left

Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces cardiovascular death and worsening heart failure in patients with chronic heart failure and reduced ejection fraction. Early initiation during an acute heart failure (AHF) hospitalization may facilitate decongestion, improve natriuresis, and facilitate safe transition to a beneficial outpatient therapy for both diabetes and heart failure.. The objective is to assess the efficacy and safety of initiating dapagliflozin within the first 24 hours of hospitalization in patients with AHF compared to usual care.. The DICTATE-AHF trial will establish the efficacy and safety of early initiation of dapagliflozin during AHF across both AHF and diabetic outcomes in patients with diabetes.

Topics: Acute Disease; Benzhydryl Compounds; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Disease Progression; Glucosides; Heart Failure; Hospital Mortality; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemic Agents; Hypotension; Hypovolemia; Insulin; Natriuresis; Natriuretic Peptide, Brain; Patient Readmission; Peptide Fragments; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Sodium Potassium Chloride Symporter Inhibitors; Sodium-Glucose Transporter 2 Inhibitors; Treatment Outcome; Weight Loss

The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure (HF) hospitalization in HF patients with a reduced ejection fraction (HFrEF). However, fewer than 1% of patients in the PARADIGM-HF study had New York Heart Association (NYHA) functional class IV symptoms. Accordingly, data that informed the use of S/V among patients with advanced HF were limited. The LIFE (LCZ696 in Hospitalized Advanced Heart Failure) study was a 24-week prospective, multicenter, double-blinded, double-dummy, active comparator trial that compared the safety, efficacy, and tolerability of S/V with those of valsartan in patients with advanced HFrEF. The trial planned to randomize 400 patients ≥18 years of age with advanced HF, defined as an EF ≤35%, New York Heart Association functional class IV symptoms, elevated natriuretic peptide concentration (B-type natriuretic peptide [BNP] ≥250 pg/ml or N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥800 pg/ml), and ≥1 objective finding of advanced HF. Following a 3- to 7-day open label run-in period with S/V (24 mg/26 mg twice daily), patients were randomized 1:1 to S/V titrated to 97 mg/103 mg twice daily versus 160 mg of V twice daily. The primary endpoint was the proportional change from baseline in the area under the curve for NT-proBNP levels measured through week 24. Secondary and tertiary endpoints included clinical outcomes and safety and tolerability. Because of the COVID-19 pandemic, enrollment in the LIFE trial was stopped prematurely to ensure patient safety and data integrity. The primary analysis consists of the first 335 randomized patients whose clinical follow-up examination results were not severely impacted by COVID-19. (Entresto [LCZ696] in Advanced Heart Failure [LIFE STUDY] [HFN-LIFE]; NCT02816736).

Topics: Aminobutyrates; Angiotensin Receptor Antagonists; Betacoronavirus; Biphenyl Compounds; Cardiotonic Agents; Coronavirus Infections; COVID-19; Dose-Response Relationship, Drug; Double-Blind Method; Drug Combinations; Early Termination of Clinical Trials; Glomerular Filtration Rate; Heart Failure; Heart Transplantation; Heart-Assist Devices; Hospitalization; Humans; Hypotension; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; SARS-CoV-2; Stroke Volume; Tetrazoles; Valsartan

We aimed to evaluate the clinical performance of early administration of recombinant human B-type natriuretic peptide (rhBNP) to ST-elevation myocardial infarction (STEMI) patients receiving percutaneous coronary intervention (PCI) treatment.. In total, 185 patients diagnosed with STEMI were enrolled and randomised into either the placebo-treated (n = 88) or rhBNP-treated (n = 97) group. Patients were given either saline or rhBNP ten minutes before PCI and monitored with various cardiac parameters, including accelerated idioventricular rhythm, frequent ventricular premature beat (FVPB), ventricular tachycardia, systolic blood pressure, thrombolysis in myocardial infarction (TIMI) 3 gradation, corrected TIMI frame count (cTFC) and myocardial blush grade (MBG) 3 classification.. Our results revealed no difference in accelerated idioventricular rhythm between the two groups. However, FVPB and ventricular tachycardia were significantly decreased in rhBNP-treated patients compared to placebo-treated patients (p < 0.05). Moreover, the occurrence ratio of reperfusion-associated low blood pressure in rhBNP-treated patients was lower than in placebo-treated patients (p = 0.03), while no difference was observed in infarction-related arteries TIMI 3 blood flow between the two groups (p = 0.23). Importantly, measurement of post-reperfusion blood flow velocity via cTFC suggested that rhBNP treatment could significantly increase blood circulation (p = 0.003). After stent implantation, the acquisition rate of MBG 3 was higher in rhBNP-treated patients compared to placebo-treated patients (p = 0.071), although the difference was not significant.. We concluded that early administration of rhBNP can ameliorate the severity of reperfusion injury for STEMI patients receiving PCI treatment.

Topics: Aged; Arrhythmias, Cardiac; Coronary Circulation; Electrocardiography; Female; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Recombinant Proteins; Reperfusion Injury; ST Elevation Myocardial Infarction; Stents; Tachycardia, Ventricular; Treatment Outcome

In patients with acute heart failure, early intervention with an intravenous vasodilator has been proposed as a therapeutic goal to reduce cardiac-wall stress and, potentially, myocardial injury, thereby favorably affecting patients' long-term prognosis.. In this double-blind trial, we randomly assigned 2157 patients with acute heart failure to receive a continuous intravenous infusion of either ularitide at a dose of 15 ng per kilogram of body weight per minute or matching placebo for 48 hours, in addition to accepted therapy. Treatment was initiated a median of 6 hours after the initial clinical evaluation. The coprimary outcomes were death from cardiovascular causes during a median follow-up of 15 months and a hierarchical composite end point that evaluated the initial 48-hour clinical course.. Death from cardiovascular causes occurred in 236 patients in the ularitide group and 225 patients in the placebo group (21.7% vs. 21.0%; hazard ratio, 1.03; 96% confidence interval, 0.85 to 1.25; P=0.75). In the intention-to-treat analysis, there was no significant between-group difference with respect to the hierarchical composite outcome. The ularitide group had greater reductions in systolic blood pressure and in levels of N-terminal pro-brain natriuretic peptide than the placebo group. However, changes in cardiac troponin T levels during the infusion did not differ between the two groups in the 55% of patients with paired data.. In patients with acute heart failure, ularitide exerted favorable physiological effects (without affecting cardiac troponin levels), but short-term treatment did not affect a clinical composite end point or reduce long-term cardiovascular mortality. (Funded by Cardiorentis; TRUE-AHF ClinicalTrials.gov number, NCT01661634 .).

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Cardiovascular Diseases; Diuretics; Double-Blind Method; Female; Follow-Up Studies; Heart Failure; Humans; Hypotension; Infusions, Intravenous; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Troponin T

Intradialytic hypotension (IDH) is associated with morbidity. The effect of blood volume-guided ultrafiltration biofeedback, which automatically adjusts fluid removal rate on the basis of blood volume parameters, on the reduction of IDH was tested in a randomized crossover trial.. We performed a 22-week, single blind, randomized crossover trial in patients receiving maintenance hemodialysis who had >30% of sessions complicated by symptomatic IDH in five centers in Calgary, Alberta, Canada. Participants underwent a 4-week run-in period to standardize dialysis prescription and dry weight on the basis of clinical examination. Those meeting inclusion criteria were randomized to best clinical practice hemodialysis (control) or best clinical practice plus blood volume-guided ultrafiltration biofeedback (intervention) for 8 weeks, followed by a 2-week washout and subsequent crossover for a second 8-week phase. The primary outcome was rate of symptomatic IDH.. The use of blood volume monitoring-guided ultrafiltration biofeedback in patients prone to IDH did not reduce the rate of symptomatic IDH events.

Topics: Aged; Aged, 80 and over; Blood Volume; Blood Volume Determination; Cross-Over Studies; Extracellular Fluid; Feedback, Physiological; Female; Humans; Hypotension; Kidney Failure, Chronic; Male; Middle Aged; Natriuretic Peptide, Brain; Renal Dialysis; Single-Blind Method; Troponin; Ultrafiltration; Water-Electrolyte Balance; Weight Gain

Aim of the present study is to investigate the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) and dopamine combination treatment in patients with cardiorenal syndrome type 4 (CRS4) combined with hypotension. A total of 160 CRS4 patients admitted to our hospital from July 2010 to December 2014 were recruited, and were randomly divided into two groups, the observational group (n=80) and the control group (n=80). CRS4 patients treated with dopamine were recruited into the control group. Patients in the observational group were given rhBNP and dopamine combination treatment once every 8 h. Both groups received conventional treatments and the course of treatment was 7 days. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), serum creatinine (SCr), N-terminal brain natriuretic peptide precursor (Nt-proBNP), creatinine clearance (CCr), left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), Stroke volume (SV), urine volume and adverse reactions before and after treatment were compared. The observational group showed significant changes in the levels of SBP, DBP and HR compared with the control group (P<0.05). The levels of SCr and Nt-proBNP decreased significantly in the observational group than those in the control group (P<0.05). The levels of CCr, LVEF, SV and urine volume increased significantly in the observational group than those in the control group (P<0.05). Patients in the observational group had mild and tolerable adverse reactions. rhBNP combined with dopamine infusion has good clinical efficacy and mild adverse effects in treatment of CRS4.

Topics: Adult; Aged; Aged, 80 and over; Blood Pressure; Cardio-Renal Syndrome; Dopamine; Drug Therapy, Combination; Female; Glomerular Filtration Rate; Heart Rate; Hemodynamics; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Recombinant Proteins; Recovery of Function; Time Factors; Treatment Outcome; Ventricular Function, Left

Fluid overload is associated with adverse outcomes in hemodialysis (HD) patients. The precise assessment of hydration status in HD patients remains a major challenge for nephrologists. Our study aimed to explore whether combining two bedside methods, lung ultrasonography (LUS) and bioimpedance, may provide complementary information to guide treatment in specific HD patients.. In total, 250 HD patients from two dialysis units were included in this randomized clinical trial. Patients were randomized 1:1 to have a dry weight assessment based on clinical (control) or LUS with bioimpedance in case of clinical hypovolemia (active)-guided protocol. The primary outcome was to assess the difference between the two groups on a composite of all-cause mortality and first cardiovascular event (CVE)-including death, stroke, and myocardial infarction.. During a mean follow-up period was 21.3 ± 5.6 months, there were 54 (21.6%) composite events in the entire population. There was a nonsignificant 9% increase in the risk of this outcome in the active arm (HR = 1.09, 95% CI 0.64-1.86, p = 0.75). Similarly, there were no differences between the two groups when analyzing separately the all-cause mortality and CVE outcomes. However, patients in the active arm had a 19% lower relative risk of pre-dialytic dyspnea (rate ratio-0.81, 95% CI 0.68-0.96), but a 26% higher relative risk of intradialytic cramps (rate ratio-1.26, 95% CI 1.16-1.37).. This study shows that a LUS-bioimpedance-guided dry weight adjustment protocol, as compared to clinical evaluation, does not reduce all-cause mortality and/or CVE in HD patients. A fluid management protocol based on bioimpedance with LUS on indication might be a better strategy.

Topics: Adult; Aged; Body Composition; Body Water; Body Weight; Cause of Death; Electric Impedance; Female; Follow-Up Studies; Hemodialysis Solutions; Hospitalization; Humans; Hypotension; Kidney Failure, Chronic; Lung; Male; Middle Aged; Monitoring, Physiologic; Muscle Cramp; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Pulse Wave Analysis; Renal Dialysis; Risk Assessment; Stroke; Troponin T; Ultrasonography; Vascular Stiffness

Outcomes associated with episodes of hypotension while hospitalized with acute decompensated heart failure are not well understood.. Using data from Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF), we assessed factors associated with in-hospital hypotension and subsequent 30-day outcomes. Patients were classified as having symptomatic or asymptomatic hypotension. Multivariable logistic regression was used to determine factors associated with in-hospital hypotension, and Cox proportional hazards models were used to assess the association between hypotension and 30-day outcomes. We also tested for treatment interaction with nesiritide on 30-day outcomes and the association between in-hospital hypotension and renal function at hospital discharge. Overall, 1555 of 7141 (21.8%) patients had an episode of hypotension, of which 73.1% were asymptomatic and 26.9% were symptomatic. Factors strongly associated with in-hospital hypotension included randomization to nesiritide (odds ratio, 1.98; 95% confidence interval [CI], 1.76-2.23; P<0.001), chronic metolazone therapy (odds ratio, 1.74; 95% CI, 1.17-2.60; P<0.001), and baseline orthopnea (odds ratio, 1.31; 95% CI, 1.13-1.52; P=0.001) or S3 gallop (odds ratio, 1.21; 95% CI, 1.06-1.40; P=0.006). In-hospital hypotension was associated with increased hazard of 30-day mortality (hazard ratio, 2.03; 95% CI, 1.57-2.61; P<0.001), 30-day heart failure hospitalization or mortality (hazard ratio, 1.58; 95% CI, 1.34-1.86; P<0.001), and 30-day all-cause hospitalization or mortality (hazard ratio, 1.40; 95% CI, 1.22-1.61; P<0.001). Nesiritide had no interaction on the relationship between hypotension and 30-day outcomes (interaction P=0.874 for death, P=0.908 for death/heart failure hospitalization, P=0.238 death/all-cause hospitalization).. Hypotension while hospitalized for acute decompensated heart failure is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies.. http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

Topics: Aged; Female; Heart Failure; Hospital Mortality; Hospitalization; Humans; Hypotension; Logistic Models; Male; Middle Aged; Natriuretic Agents; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Prognosis; Proportional Hazards Models

Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent.. We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days.. Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%, P=0.03) and 24 hours (68.2% vs. 66.1%, P=0.007), but the prespecified level for significance (P≤0.005 for both assessments or P≤0.0025 for either) was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (absolute difference, -0.7 percentage points; 95% confidence interval [CI], -2.1 to 0.7; P=0.31). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo; absolute difference, -0.4 percentage points; 95% CI, -1.3 to 0.5) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5%; odds ratio, 1.09; 95% CI, 0.98 to 1.21; P=0.11).. Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. (Funded by Scios; ClinicalTrials.gov number, NCT00475852.).

Topics: Acute Disease; Aged; Double-Blind Method; Dyspnea; Female; Heart Failure; Humans; Hypotension; Intention to Treat Analysis; Kidney Diseases; Male; Middle Aged; Natriuretic Agents; Natriuretic Peptide, Brain; Patient Readmission; Recurrence

We previously reported that the fixed-dose combination of isosorbide dinitrate and hydralazine hydrochloride (FDC I/H) significantly decreased the risk of all-cause death and first hospitalization for heart failure (HF) and improved quality of life in patients with New York Heart Association class III or IV heart failure in the African-American Heart Failure Trial (A-HeFT). The current analyses further define the effect of FDC I/H on the timing of event-free survival (mortality or first hospitalization for HF) and time to first hospitalization for HF, as well as effects by subgroups and effects on cause-specific mortality.. Kaplan-Meier analyses of the 1050 A-HeFT patients on standard neurohormonal blockade demonstrated that FDC I/H produced a 37% improvement in event-free survival (P<0.001) and a 39% reduction in the risk for first hospitalization for HF (P<0.001). These benefits appeared to emerge early (at approximately 50 days of treatment) and were sustained through the duration of the trial. Subgroup analyses of treatment effect by age, sex, baseline blood pressure, history of chronic renal insufficiency, presence of diabetes mellitus, cause of HF, and baseline medication usage demonstrated consistent beneficial effect of FDC I/H on the primary composite score and event-free survival across all subgroups. Mortality from pump failure was reduced by 75% (P=0.012).. FDC I/H treatment of black patients with moderate to severe HF who were taking neurohormonal blockers produced early and sustained significant improvement in event-free survival and hospitalization for HF in the A-HeFT cohort, with significant reduction in mortality from cardiovascular and pump failure deaths. The treatment effects on the primary composite end point and event-free survival were consistent across subgroups.

Topics: Adult; Aged; Arthralgia; Biomarkers; Black or African American; Cardiovascular Agents; Cause of Death; Disease-Free Survival; Dizziness; Double-Blind Method; Drug Combinations; Heart Failure; Heart Transplantation; Hospitalization; Humans; Hydralazine; Hypotension; Isosorbide Dinitrate; Kaplan-Meier Estimate; Middle Aged; Mortality; Natriuretic Peptide, Brain; Nitric Oxide Donors; Proportional Hazards Models; Quality of Life; Surveys and Questionnaires; Treatment Outcome; Vasodilator Agents

Short daily hemodialysis (HD) has a protective effect against dialysis-induced hypotension (DIH). We examined whether this effect extends beyond the treatment period.. We analyzed clinical variables in 6 patients (5 with diabetes mellitus) who underwent conventional hemodialysis (CHD) for 4 h three times weekly for 12 weeks; then short daily HD for 2 h six times weekly for 12 weeks, and then 12 more weeks of CHD. All patients had been given vasopressors for severe DIH.. The severe DIH disappeared during the short daily HD. There were significant decreases in body weight (BW), cardiothoracic ratio (CTR), blood pressure (BP), normal saline solution (NSS) amount (62.8 +/- 26.4 vs. 9.8 +/- 7.4 ml/session, p < 0.05), frequency (0.60 +/- 0.26 vs. 0.10 +/- 0.07 infusions/session, p < 0.05) and postdialysis atrial natriuretic peptide (ANP) (176.8 +/- 56.4 vs. 104.8 +/- 42.3 pg/ml, p < 0.05). Weekly ultrafiltration volume (6.3 +/- 0.9 vs. 7.9 +/- 0.7 l, p < 0.05) was significantly higher during the short daily HD period than during the first CHD period. The vasopressor treatment was therefore stopped or reduced in all patients during the short daily HD period. Because DIH recurred in the second CHD period despite a significant increase in BP, the vasopressor treatment was resumed in 5 patients. BW, CTR, NSS infusion amount and frequency, or postdialysis ANP did not differ significantly between the short daily HD and second CHD periods.. The protective effect of short daily HD against DIH lasted more than 12 weeks after the treatment ended. We therefore conclude that temporary short daily HD is useful for preventing DIH.

Topics: Aged; Anemia; Antihypertensive Agents; Appointments and Schedules; Arteriovenous Shunt, Surgical; Atrial Natriuretic Factor; Blood Pressure; Body Weight; Diabetic Nephropathies; Echocardiography; Erythropoietin; Female; Ferritins; Humans; Hypertension, Renal; Hypotension; Iron; Kidney Failure, Chronic; Male; Middle Aged; Natriuretic Peptide, Brain; Quality of Life; Recombinant Proteins; Renal Dialysis; Uremia

The Prospective Randomized Outcomes study of Acutely decompensated Congestive heart failure Treated Initially as Outpatients with Nesiritide (PROACTION) trial evaluated the safety of nesiritide administration in the emergency department in patients with decompensated heart failure. Patients (N=237) were treated for at least 12 hours with standard care plus either intravenous nesiritide or placebo. Compared to placebo, nesiritide favorably decreased systolic blood pressure (SBP) in patients with elevated baseline SBP, without negatively impacting patients with lower baseline SBP (SBP, >140 mm Hg: nesiritide, -28.7 mm Hg, vs placebo, -8.4 mm Hg [P<.001]; SBP, 101-140 mm Hg: nesiritide, -12.3 mm Hg, vs placebo, -5 mm Hg [P<.017]; SBP, <101 mm Hg: nesiritide, -1.2 mm Hg vs placebo, +16.7 mm Hg [P<.03]). Both treatment groups had similar incidences of symptomatic and asymptomatic hypotension. These data demonstrate that early administration of nesiritide in the emergency department is a safe and effective treatment of heart failure.

Topics: Aged; Blood Pressure; Double-Blind Method; Emergency Service, Hospital; Female; Heart Failure; Humans; Hypotension; Male; Natriuretic Agents; Natriuretic Peptide, Brain

The objective of this study was to address the feasibility and the biological activity of orally administered human brain natriuretic peptide (hBNP). Proprietary technology has been developed in which short, amphiphilic oligomers are covalently attached to peptides. The conjugated peptides are intended to have an improved pharmacokinetic profile and to enable oral administration. We hypothesized that novel oral conjugated hBNP (CONJ-hBNP) increases plasma hBNP, activates cGMP, and reduces mean arterial pressure (MAP).. This randomized crossover-designed study tested the biological activity of oral CONJ-hBNP compared with oral native hBNP in normal conscious dogs. Measurements of MAP, plasma hBNP, and cGMP were made at baseline (BL) and repeated at 10, 30, 60, 120, 180, and 240 minutes after oral administration. Plasma hBNP was not detectable in dogs at BL. Plasma hBNP was detected after native hBNP and CONJ-HBNP administration. However, plasma hBNP concentration was significantly higher after CONJ-hBNP than after native hBNP administration (P=0.0374 between groups). Plasma cGMP increased after CONJ-hBNP for 60 minutes (from 10.8+/-3 to 36.8+/-26 pmol/mL; P<0.05), whereas it did not change after native hBNP (P=0.001 between groups). MAP decreased at 10 minutes and remained decreased for 60 minutes after CONJ-hBNP (from 113+/-8 to 101+/-12 mm Hg after 10 minutes to 97.5+/-10 mm Hg after 30 minutes to 99+/-13 mm Hg after 60 minutes) while remaining unchanged after native hBNP (P=0.0387 between groups).. This study reports for the first time that novel conjugated oral BNP activates cGMP and significantly reduces MAP, thus implying an efficacious coupling of CONJ-hBNP to the natriuretic receptor-A. These data advance a new concept of orally administered chronic BNP therapy for cardiovascular diseases.

Topics: Administration, Oral; Animals; Blood Pressure; Cross-Over Studies; Cyclic GMP; Dogs; Humans; Hypotension; Male; Models, Animal; Natriuretic Peptide, Brain

Intravenous infusion of nesiritide, a brain (B-type) natriuretic peptide, has beneficial hemodynamic effects in patients with decompensated congestive heart failure. We investigated the clinical use of nesiritide in such patients.. Patients hospitalized because of symptomatic congestive heart failure were enrolled in either an efficacy trial or a comparative trial. In the efficacy trial, which required the placement of a Swan-Ganz catheter, 127 patients with a pulmonary-capillary wedge pressure of 18 mm Hg or higher and a cardiac index of 2.7 liters per minute per square meter of body-surface area or less were randomly assigned to double-blind treatment with placebo or nesiritide (infused at a rate of 0.015 or 0.030 microg per kilogram of body weight per minute) for six hours. In the comparative trial, which did not require hemodynamic monitoring, 305 patients were randomly assigned to open-label therapy with standard agents or nesiritide for up to seven days.. In the efficacy trial, at six hours, nesiritide infusion at rates of 0.015 and 0.030 microg per kilogram per minute decreased pulmonary-capillary wedge pressure by 6.0 and 9.6 mm Hg, respectively (as compared with an increase of 2.0 mm Hg with placebo, P<0.001), resulted in improvements in global clinical status in 60 percent and 67 percent of the patients (as compared with 14 percent of those receiving placebo, P<0.001), reduced dyspnea in 57 percent and 53 percent of the patients (as compared with 12 percent of those receiving placebo, P<0.001), and reduced fatigue in 32 percent and 38 percent of the patients (as compared with 5 percent of those receiving placebo, P<0.001). In the comparative trial, the improvements in global clinical status, dyspnea, and fatigue were sustained with nesiritide therapy for up to seven days and were similar to those observed with standard intravenous therapy for heart failure. The most common side effect was dose-related hypotension, which was usually asymptomatic.. In patients hospitalized with decompensated congestive heart failure, nesiritide improves hemodynamic function and clinical status. Nesiritide is useful for the treatment of decompensated congestive heart failure.

Topics: Atrial Natriuretic Factor; Cardiotonic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Dyspnea; Fatigue; Female; Heart Failure; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Wedge Pressure; Vasodilator Agents

Previous studies reported that the use of natriuretic peptides (NPs) can effectively decrease arrhythmias. However, there is a lack of clinical evidence that recombinant human brain natriuretic peptide (rh-BNP) inhibits postoperative atrial fibrillation (POAF). This cohort aims to assess the effect of rh-BNP on POAF. This study retrospectively reviewed patients who underwent isolated coronary artery bypass grafting from January 2018 to January 2021. Patients were divided into 2 groups according to whether they received rh-BNP therapy within 5 days after surgery. A total of 1153 patients met the inclusion and exclusion criteria, of which 54 received rh-BNP therapy within 5 days. After propensity score matching, 53 patients were treated with rh-BNP, and 148 patients were not treated with rh-BNP. The incidence of POAF was lower in rh-BNP group than non-rh-BNP group (18.9% vs. 37.2%, odds ratio = 0.393, 95% confidence interval, 0.183-0.845, P = 0.017). There was no significant difference in the occurrence of ventricular arrhythmia ( P = 0.4), hypotension ( P = 0.763), and the risk of death ( P = 0.14). rh-BNP could significantly reduce the occurrence of POAF after coronary artery bypass grafting, and rh-BNP did not increase the risk of ventricular arrhythmia, hypotension, and death. Accordingly, rh-BNP could be a potential safe medicine for preventing POAF.

Topics: Atrial Fibrillation; Coronary Artery Bypass; Humans; Hypotension; Natriuretic Peptide, Brain; Postoperative Complications; Retrospective Studies; Risk Factors

Many Fontan patients with and without systolic ventricular dysfunction are being treated with angiotensin-converting enzyme (ACE) inhibitors, despite its effectiveness remaining unclear. In the present study, we evaluated the short-term effect of enalapril on exercise capacity, vascular and ventricular function in pediatric Fontan patients with moderate-good systolic ventricular function. Fontan patients between 8 and 18 years with moderate-good systolic ventricular function and without previous ACE inhibitor treatment were included and were treated with enalapril for 3 months. During the first 2 weeks, the dosage was titrated according to systolic blood pressure (SBP). Exercise tests, ventricular function assessed by echocardiography, arterial stiffness measurements, and plasma levels of N-terminal pro-B-type natriuretic peptide assessed before and after a 3-month enalapril treatment period was compared. A total of 28 Fontan patients (median age 13.9 years, 6 to 15 years after Fontan operation) completed the study with a mean dosage of 0.3 ± 0.1 mg/kg/d. A total of 6 patients (21%) experienced a significant drop in SBP and 6 others (21%) experienced other adverse events. Enalapril treatment lowered the SBP (from 110 to 104 mmHg, p = 0.003) and levels of N-terminal pro-B-type natriuretic peptide (from 80 to 72 ng/L, p = 0.036). However, enalapril treatment did not improve exercise capacity, ventricular function, or arterial stiffness. In conclusion, short-term ACE inhibition has no beneficial effect in Fontan patients with moderate-good systolic ventricular function.

Topics: Adolescent; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Child; Echocardiography; Enalapril; Exercise Test; Exercise Tolerance; Female; Fontan Procedure; Humans; Hypotension; Male; Natriuretic Peptide, Brain; Peptide Fragments; Systole; Treatment Outcome; Vascular Stiffness; Ventricular Dysfunction

Despite evidence of hemodynamic benefit of sodium nitroprusside (SNP) treatment for acute heart failure (AHF), there are limited data about its efficacy and safety. This study aimed to assess the effectiveness and safety of SNP treatment, to explore the impact of N-terminal pro-B natriuretic peptide (NT-proBNP) reduction on clinical endpoints and to identify possible predictors of clinical response.. Multicenter retrospective cohort study of 200 patients consecutively admitted for AHF in 2 Italian Centers. Primary endpoint was the reduction of NT-proBNP levels ≥25% from baseline values within 48 h from the onset of SNP infusion. Secondary and safety endpoints included all-cause mortality, rehospitalization for HF at 1, 3 and 6 months, length of hospital stay (LOS) and severe hypotension. 131 (66%) patients experienced a NT-proBNP reduction ≥25% within 48 h from treatment onset, irrespective of initial systolic blood pressure (SBP). Left ventricular end diastolic diameter (LVEDD) was the only independent predictor of treatment efficacy. Patients who achieved the primary endpoint (i.e., 'responders') had lower LOS (median 15 [IQR:10-27] vs 19 [IQR:12-35] days, p-value = 0.033) and a lower incidence of all-cause mortality and rehospitalization for HF at 1 and 3 months compared to "non responders" (p-value <0.050). Severe hypotension was observed in 10 (5%) patients, without any adverse clinical consequence.. SNP is a safe and effective treatment of AHF, particularly in patients with dilated left ventricle. Reduced NT-proBNP levels in response to SNP is associated to shorter LOS and lower risk of 1- and 3-month re-hospitalizations for HF.. http://www.. gov. Unique identifier: NCT05027360.

Topics: Biomarkers; Cohort Studies; Heart Failure; Humans; Hypotension; Natriuretic Peptide, Brain; Nitroprusside; Peptide Fragments; Prognosis; Retrospective Studies; Stroke Volume

Topics: Abdominal Pain; Acute Kidney Injury; Adolescent; Adult; Asthenia; Chest Pain; Conjunctivitis; Coronary Angiography; Coronary Care Units; COVID-19; Diarrhea; Dyspnea; Electrocardiography; Exanthema; Extracorporeal Membrane Oxygenation; Female; Fever; France; Headache; Humans; Hypotension; Intensive Care Units; Magnetic Resonance Imaging; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Natriuretic Peptide, Brain; Peptide Fragments; Respiration, Artificial; SARS-CoV-2; Stroke Volume; Systemic Inflammatory Response Syndrome; Tachycardia; Troponin; Ventricular Dysfunction, Left; Young Adult

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.

Topics: Adult; Alkalosis, Respiratory; Bell Palsy; Blood Gas Analysis; C-Reactive Protein; COVID-19; Echocardiography; Edema; Electrocardiography; Humans; Hypotension; Lymphadenitis; Magnetic Resonance Imaging; Male; Myocarditis; Natriuretic Peptide, Brain; Neck; Oxygen Inhalation Therapy; Peptide Fragments; Procalcitonin; Recovery of Function; SARS-CoV-2; Troponin T; Vasoconstrictor Agents

Topics: Aged; Aged, 80 and over; Biomarkers; Blood Pressure; Blood Proteins; Female; Humans; Hypotension; Hypovolemia; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Renal Dialysis; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

B-type natriuretic peptide (BNP) is secreted by ventricular cardiomyocytes in response to various types of cardiac stress and has been used as a heart failure marker. In septic patients, increased BNP suggests poor prognosis; however, no causal link has been established. Among various effects, BNP decreases systemic vascular resistance and increases natriuresis that leads to lower blood pressure. We previously observed that JNK inhibition corrects cardiac dysfunction and suppresses cardiac BNP mRNA in endotoxemia. In this study, we investigated the transcriptional mechanism that regulates BNP expression and the involvement of plasma BNP in causing septic hypotension. Our in vitro and in vivo findings confirmed that activation of JNK signaling increases BNP expression in sepsis via direct binding of c-Jun in activating protein-1 (AP-1) regulatory elements of the Nppb promoter. Accordingly, genetic ablation of BNP, as well as treatment with a potentially novel neutralizing anti-BNP monoclonal antibody (19B3) or suppression of its expression via administration of JNK inhibitor SP600125 improved cardiac output, stabilized blood pressure, and improved survival in mice with polymicrobial sepsis. Therefore, inhibition of JNK signaling or BNP in sepsis appears to stabilize blood pressure and improve survival.

Topics: Animals; Cell Line; Humans; Hypotension; JNK Mitogen-Activated Protein Kinases; Mice; Natriuretic Peptide, Brain; Sepsis; Up-Regulation

To screen the clinical parameters in predicting continuous renal replacement therapy (CRRT)-related hypotension in the patients with renal failure.. A retrospective analysis was conducted. Patients with renal failure received CRRT admitted to Qingdao Municipal Hospital from July 1st, 2012 to June 30th 2019 were enrolled. Clinical data was recorded for the patients, including gender, age, weight, parameters before CRRT [systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP), heart rate, blood routine examination, blood biochemistry, B-type natriuretic peptide (BNP), cardiothoracic ratio, left ventricular ejection fraction (LVEF)], CRRT duration, blood flow velocity, replacement fluid volume, net ultrafiltration volume, ultrafiltration rate and 30-day prognosis. The patients who had CRRT-related hypotension or whose net ultrafiltration was zero were enrolled as intolerance ultrafiltration group. Others were enrolled in normal ultrafiltration group. The parameters of the patients in the two groups were compared, and their predictive values in CRRT-related hypotension were evaluated by receiver operating characteristic (ROC) curve analysis.. The values of age, BNP and CVP are more useful than other parameters in predicting CRRT-related hypotension before the start.

Topics: Continuous Renal Replacement Therapy; Humans; Hypotension; Natriuretic Peptide, Brain; Prognosis; Retrospective Studies; ROC Curve; Stroke Volume; Ventricular Function, Left

Bioimpedance can be used to measure extracellular water (ECW) and total body water in hemodialysis (HD) patients and estimate ECW excess. However, ECW excess potentially includes both an increase in the plasma volume and also the extravascular volume. Overestimating the amount of fluid to be removed during HD risks intra-dialytic hypotension. We wished to determine the association between estimates of ECW excess comparing several different equations using bioimpedance, brain N-terminal pro-brain natriuretic peptide (NT-proBNP) with cardiac chamber volumes and function as determined by cardiac magnetic resonance imaging pre-HD measurements of ECW and total body water were made using multifrequency bioimpedance and cardiac chamber sizes and function were determined by magnetic resonance imaging. Thirty patients, 20 males (66.7%), mean age 64.4 ± 15.3 years were studied. ECW and ECW/height were positively associated with indexed right ventricular end-systolic (RVESVi) and end-diastolic volume (RVEDVi) (RVESi r = 0.46, r = 0.43; RVEDi r = 0.50, r = 0.44, all P < 0.05), but not with left sided cardiac volumes. Whereas NT-proBNP was associated with indexed left atrial and ventricular size (r = 0.47, r = 0.58, P < 0.05), but not right sided cardiac volumes. Pre-HD NT-proBNP was associated with left sided cardiac chamber sizes, but not with right sided chamber sizes, whereas ECW/height was associated with right sided cardiac chamber sizes. As right-sided cardiac chamber size is more responsive to and reflective of changes in intravascular volume than the left atrium and ventricle, then bioimpedance measured ECW is potentially more reliable in estimating plasma volume expansion.

Topics: Aged; Comparative Effectiveness Research; Electric Impedance; Female; Heart Ventricles; Humans; Hypotension; Kidney Failure, Chronic; Magnetic Resonance Imaging; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Size; Peptide Fragments; Plasma Volume; Renal Dialysis; Reproducibility of Results

Bezold-Jarisch reflex (BJR) occurs when the cardioinhibitory receptors in the walls of ventricles are activated by various stimuli, with typical features of bradycardia, vasorelaxation, and hypotension. This reflex usually happens in parturient intrathecal anesthesia, as a result of decreased venous return by compression of inferior vena cava, but it is only rarely reported during general anesthesia.. Severe bradycardia and hypotension, indicating BJR, occurred during the induction of general anesthesia in a 3-month-old female child with giant intra-abdominal teratoma.. A giant intra-abdominal teratoma was detected by computed tomography scanning. The decreased left ventricular ejection faction along with increased troponin I and N-terminal pro-B-type natriuretic peptide indicated a preoperative mild cardiac dysfunction. BJR was diagnosed on the basis of the severe bradycardia and hypotension observed during the induction of general anesthesia, INTERVENTIONS:: Atropine failed to increase heart rate. Cardiopulmonary resuscitation was initiated immediately and epinephrine was injected intravenously because of sudden circulatory collapse. Soon after the return of spontaneous circulation, a central venous line was placed and invasive blood pressure was monitored. Vital signs and homeostasis were kept stable during teratoma resection.. The child was extubated after emergence from anesthesia in the operating room. Eleven days later, she had recovered without complications and was discharged.. General anesthesia should be induced with great care in patients with giant intra-abdominal masses, and the patient should be kept in the left-lateral table tilt position before induction.

Topics: Abdominal Neoplasms; Bradycardia; Cardiopulmonary Resuscitation; Dissection; Female; Humans; Hypotension; Infant; Natriuretic Peptide, Brain; Peptide Fragments; Reflex, Abnormal; Stroke Volume; Teratoma; Tomography, X-Ray Computed; Treatment Outcome; Troponin I; Tumor Burden; Vasodilation; Ventricular Dysfunction, Left

Early assessment and aggressive hemodynamic treatment have been shown to increase the survival of patients in septic shock. Current and past sepsis guidelines recommend a resuscitation protocol including central venous pressure (CVP), mean arterial blood pressure (MAP), urine output and central venous oxygen saturation (ScvO2) for resuscitation within the first six hours. Currently, the established severity score systems like APACHE II score, SOFA score or SAPS II score predict the outcome of critically ill patients on the bases of variables obtained only after the first 24 hours. The present study aims to evaluate the risk of short-term mortality for patients with septic shock by the earliest possible assessment of hemodynamic parameters and cardiac biomarkers as well as their role for the prediction of the adverse outcome.. 52 consecutive patients treated for septic shock in the intensive care unit of one centre (Marien Hospital Herne, Ruhr University Bochum, Germany) were prospectively enrolled in this study. Hemodynamic parameters (MAP, CVP, ScvO2, left ventricular ejection fraction, Hematocrit) and cardiac biomarkers (Troponin I) at the ICU admission were evaluated in regard to their influence on mortality. The primary endpoint was all-cause mortality within 28 days after the admission.. A total of 52 patients (31 male, 21 female) with a mean age of 71.4±8.5 years and a mean APACHE II score of 37.0±7.6 were enrolled in the study. 28 patients reached the primary endpoint (mortality 54%). Patients presenting with hypotension (MAP <65 mmHg) at ICU admission had significantly higher rates of 28-day mortality as compared with the group of patients without hypotension (28-day mortality rate 74 % vs. 32 %, p<0.01). Furthermore, the patients in the hypotension present group had significantly higher lactate concentration (p=0.002), higher serum creatinin (p=0.04), higher NTproBNP (p=0.03) and after the first 24 hours higher APACHE II scores (p=0.04). A MAP <65 mmHg was the only hemodynamic parameter significantly predicting the primary endpoint (OR: 4.1, CI: 1.1 - 14.8, p=0.008), whereas the remaining hemodynamic variables CVP, ScvO2, Hematocrit, Troponin I and left ventricular ejection fraction (LVEF) seemed to have no influence on survival. Besides, non-survivors had a significantly higher age (74.1±9.0 vs. 68.4±6.9, p=0.01). If hypotension coincided with an age ≥72 years, the 28-day mortality rate escalated to 88%.. In our study, we identified a risk group with an exceedingly high mortality rate: the patients with an age ≥72 years and presenting with hypotension (MAP <65 mmHg). These data can be easily obtained at the time of the very first patient contact. As a result, an aggressive and a more effective treatment can be initiated within the first minutes of the primary care, possibly reducing organ failure and short-term mortality in this risk group.

Topics: Aged; Biomarkers; Blood Pressure; Echocardiography; Female; Heart; Hemodynamics; Humans; Hypotension; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Point-of-Care Testing; Predictive Value of Tests; Prospective Studies; Shock, Septic; Survival Rate; Troponin I

Several factors have been associated with mortality in the months after PE. Factors associated with short-term clinical deterioration or need for hospital-based intervention are less well known.. We prospectively enrolled consecutive emergency department patients with PE and recorded clinical, biomarker and radiographic data. We assessed hospitalised patients daily to identify clinical deterioration or need for hospital-based intervention for 5 days after PE. We captured postdischarge events via 5-day and 30-day interviews. We used univariate and multivariable models to assess associations with clinical deterioration, severe clinical deterioration and 30-day all-cause mortality. We also assessed the test characteristics of three published clinical decision rules.. We enrolled 298 patients with PE: mean age 59 (SD±17) years; 152 (51%) male and 268 (90%) white race. 101 (34%) patients clinically deteriorated or required a hospital-based intervention within 5 days, and 197 (66%) did not. 27 (9%) patients suffered severe clinical deterioration and 12 died within 30 days. Factors independently associated with clinical deterioration were hypotension (p=0.001), hypoxia (p<0.001), coronary disease (p=0.004), residual deep vein thrombosis (p=0.006) and right heart strain on echocardiogram (p<0.001). In contrast, factors associated with 30-day all-cause mortality were active malignancy (p<0.001) and congestive heart failure (p=0.009). The sensitivity of clinical decision rules was moderate (39-80%) for 5-day clinical deterioration but higher (67-100%) for 30-day mortality.. Most patients do not clinically deteriorate after PE diagnosis. Several factors are associated with short-term clinical deterioration, but these factors differ from those associated with 30-day mortality.

Topics: Adult; Aged; Biomarkers; Blood Pressure; Coronary Artery Disease; Decision Support Techniques; Disease Progression; Echocardiography; Female; Heart Failure; Humans; Hypotension; Hypoxia; Male; Middle Aged; Natriuretic Peptide, Brain; Neoplasms; Oxygen; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Pulmonary Embolism; Radiography; Risk Assessment; Risk Factors; ROC Curve; Time Factors; Venous Thrombosis

Takotsubo cardiomyopathy (TTC) is increasingly well-recognized as a cause of chest-pain syndromes, especially in aging females. The most common complications of TTC occur in the first 24 hours post onset of symptoms and include shock and/or arrhythmias.. We tested the hypothesis that the severity of early hypotension in TTC reflects the extent of myocardial involvement and dysfunction.. In 80 consecutive TTC patients, correlates of blood pressure on the day of admission were sought via univariate followed by multivariate analysis.. Mean systolic blood pressure (SBP) on day 1 was 120 ± 24 (SD) mm Hg. During the first 3 days of admission, 39% of patients had SBP <90 mm Hg, and 9% died and/or required intra-aortic balloon pump insertion. The extent of release of N-terminal pro-brain natriuretic peptide, with its potential correlate of associated vasodilator activity, varied inversely with pulmonary-artery saturation, a measure of cardiac output. However, there was no significant relationship between normetanephrine release and SBP. On multivariate analyses there was no significant relationship between SBP and (1) wall-motion score index (as an index of left-ventricular systolic dysfunction) or (2) T2 enhancement on cardiac magnetic resonance imaging and peak N-terminal pro-brain natriuretic peptide (as indices of myocardial inflammation).. Although severe hypotension and shock occur commonly during acute stages of TTC, these complications are multifactorial in origin, probably representing a combination of impaired inotropic state and vasodilatation. Importantly, initial hypotension does not imply severe left ventricular inflammation or systolic dysfunction.

Topics: Aged; Aged, 80 and over; Biomarkers; Blood Pressure; Chi-Square Distribution; Female; Humans; Hypotension; Intra-Aortic Balloon Pumping; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Patient Admission; Peptide Fragments; Predictive Value of Tests; Risk Factors; Severity of Illness Index; Shock, Cardiogenic; Systole; Takotsubo Cardiomyopathy; Time Factors; Vasodilation; Ventricular Function, Left

Natriuretic peptides have been linked to cognitive disorder in previous studies. The aim of this study was to examine the association between the severity of cognitive disorder and the levels of B-type natriuretic peptide (BNP) in an older general population.. This study is a part of the larger population-based, multidisciplinary Kuopio 75+ health study. A total of 601 subjects aged 75 or older participated in the study. A subgroup of 126 individuals was diagnosed with cognitive disorder, and the severity of the disease was assessed. The participants were tested for BNP. Analysis of covariance was carried out to study the relationship between BNP and the stage of cognitive disorder.. The association between the level of cognitive disorder and BNP resembled an inverse U-shaped curve, with higher levels of BNP observed among participants with mild cognitive disorder when compared to cognitively intact participants or counterparts with more severe cognitive disorder. This effect remained after adjustment for age (P = 0.02). However, association between BNP and level of cognitive disorder was lost in further adjustment with covariates connected to the levels of BNP.. The previously reported elevation of natriuretic peptides among individuals with diagnosed cognitive disorder was found only in people with milder stages of the disorder.

Topics: Aged, 80 and over; Biomarkers; Cognition Disorders; Cohort Studies; Female; Humans; Hypotension; Male; Natriuretic Peptide, Brain

Many risk factors are known to predict ischaemic events and mortality in the elderly people, but their ranking of importance remains uncertain. This study was designed to identify and compare the main predictors of total mortality (TM), cardiovascular mortality (CVM) and non-cardiovascular mortality (NCVM) in older adults.. Nine hundred and seventy-nine community resident adults aged ≥ 65 years, free of previous heart failure and cardiovascular events, participated in the study. The univariate and multivariate (Cox regression) relationships of baseline cardiovascular risk factors, treatments and laboratory data with TM, CVM and NCVM were assessed after a median follow up of 6.7 years.. Overall, there were 104 deaths (30 because of CVM and 74 to NCVM). In multivariate analysis, the following factors remained independently associated with mortality: NT pro-B-type natriuretic peptide (NT-proBNP) upper quintile (≥ 237 pg/ml for men, ≥ 280 pg/ml for women): hazard ratio (HR) vs. the rest of the population (95% confidence interval) 2.34 (1.52-3.60), p < 0.001 for TM; HR 5.41 (2.32-12.65), p < 0.001 for CVM; systolic blood pressure lower quintile (≤ 130 mmHg): HR 3.06 (1.80-5.21), p < 0.001 for NCVM; diabetes: HR 2.46 (1.29-4.72), p = 0.007 for NCVM; erythrocyte sedimentation rate (ESR) upper decile (≥ 41 mm/h): HR 2.33 (1.16-4.69), p = 0.02 for NCVM; platelet count lower quintile (≤ 177 × 10(9) /l): HR 2.09 (1.20-3.64), p = 0.009 for NCVM; ever-smoker status: HR 2.08 (1.23-3.52), p = 0.007 for NCVM.. In elderly community dwellers, NT-proBNP was the strongest predictor of TM and CVM, while especially low systolic blood pressure, together with diabetes, ESR, reduced platelet count and ever-smoker status, were the main predictors of NCVM.

Topics: Aged; Aged, 80 and over; Biomarkers; Body Mass Index; Cardiovascular Diseases; Diabetic Angiopathies; Female; Humans; Hypotension; Kaplan-Meier Estimate; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Risk Factors; Smoking; Systole; Waist Circumference

To investigate whether low systolic blood pressure is predictive for increased mortality risk in 90-year-old subjects without heart failure, defined by low levels of NT-proBNP, as well as in 90-year-old subjects with high levels of NT-proBNP.. This study was embedded in the Leiden 85-plus Study, an observational population-based prospective study. All 90-year-old participants (n = 267) were included between 2002 and 2004 and followed up for mortality for at least 5 years. Differences in mortality risks were compared between participants with low systolic blood pressure (≤150 mmHg) and high systolic blood pressure (>150 mmHg) within strata of low NT-proBNP (<284 pg/mL for women and <306 pg/mL for men = lowest tertile) vs. high NT-proBNP (middle and highest tertile) at age 90 years. During maximal follow-up of 7.2 years, 212 participants (79%) died. Among participants with low NT-proBNP, low systolic blood pressure gave a two-fold increased risk (hazard ratio 2.0, 95% confidence interval 1.1-3.4) compared with participants with high systolic blood pressure. For participants with high NT-proBNP, low systolic blood pressure provided a 1.7 increased mortality risk (95% confidence interval 1.2-2.3) compared with high systolic blood pressure.. Low systolic blood pressure is predictive for increased mortality risk in 90-year-old subjects, irrespective of the NT-proBNP level. Therefore, the absence or presence of heart failure as determined by NT-proBNP does not influence the prognostic value of low systolic blood pressure with regard to mortality in the oldest old.

Topics: Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Heart Failure; Humans; Hypotension; Male; Natriuretic Peptide, Brain; Netherlands; Peptide Fragments; Prognosis; Prospective Studies; Risk Factors

Hyponatremia is known to be a poor prognostic factor in patients hospitalized with heart failure (HF), however not well studied in Japan. The aims of this study were to characterize hyponatremic hospitalized patients with HF and to clarify the relations between hyponatremia and detailed in-hospital outcomes in Japan. Among 4,837 hospitalized patients with HF enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, patient characteristics and in-hospital mortality in those with hyponatremia were examined. Hyponatremia (sodium <135 mEq/L) was observed in 11.6% of patients. Patients with hyponatremia were of similar age, included fewer men, and had a higher proportion of previous hospitalizations for HF compared to those with normonatremia. On admission, lower heart rates and blood pressures and higher brain natriuretic peptide levels were observed in patients with hyponatremia. During hospitalization, inotrope levels and mechanical device use were significantly higher in patients with hyponatremia. Rates of all-cause and cardiac death were significantly higher in patients with hyponatremia, 15.0% and 11.4%, respectively, compared to 5.3% and 3.6%, respectively, in those with normonatremia. In hyponatremic hospitalized patients with HF, cardiac death accounted for 76.2% of all-cause death. In conclusion, the present study demonstrates that in Japan hyponatremia in patients hospitalized with HF is relatively common and is associated with a very high in-hospital mortality.

Topics: Aged; Biomarkers; Chi-Square Distribution; Echocardiography; Female; Heart Failure; Heart Rate; Hospital Mortality; Humans; Hyponatremia; Hypotension; Japan; Male; Natriuretic Peptide, Brain; Prospective Studies; Registries; Risk Factors; Statistics, Nonparametric

Although the B-type natriuretic peptide (BNP) levels in the umbilical cord blood (UCB-BNP) and amniotic fluid (AF-BNP) of neonates may be clinically useful for identifying newborns with cardiac dysfunction, the effects of various clinical factors, such as gestational age at birth, small for gestational age (SGA), and neonatal asphyxia, on the UCB-BNP and AF-BNP levels have not been studied extensively.. The present study sought to determine whether the UCB-BNP and AF-BNP levels can predict cardiac dysfunction and hypotension in preterm infants soon after birth and to evaluate the association between BNP and various clinical factors. The UCB-BNP and AF-BNP levels at birth were determined in 320 and 195 neonates, respectively, born to mothers with singleton pregnancies.. The UCB-BNP and AF-BNP levels in infants treated with dopamine were significantly higher than those in infants without dopamine administration (230.1 vs 33.1 pg/mL and 74.4 vs 18.1 pg/mL, respectively). Stepwise multiple regression analyses indicated that gestational age, SGA, asphyxia, and chorioamnionitis were significant independent determinants of the UCB-BNP level. Cut-off values of >90 pg/mL for UCB-BNP and >36 pg/mL for AF-BNP yielded sensitivities of 68% and 93%, respectively, and specificities of 84% and 81%, respectively, for detecting neonates who required dopamine administration after birth.. High UCB-BNP and AF-BNP levels predict neonatal cardiac dysfunction soon after birth.

Topics: Adult; Amniotic Fluid; Chorioamnionitis; Dopamine; Echocardiography; Female; Fetal Blood; Heart Diseases; Humans; Hypotension; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Pregnancy; Prospective Studies; Regression Analysis; Young Adult

Topics: Antipsychotic Agents; Arrhythmias, Cardiac; Drug Monitoring; Electrocardiography; Female; Heart Conduction System; Humans; Hypotension; Male; Natriuretic Peptide, Brain; Peptide Fragments

We aimed at studying the acute cardiotoxicity of the most commonly used antipsychotics in Egypt using QTc interval and NT-proBNP as markers for the early detection of such cases. Eighty-two admitted patients, at El-Minia PCC (period from 1-7-2005 to 30-6-2010), were classified into 3 groups: I: acute thioridazine overdose (n = 28), II: acute pimozide overdose (n = 23), and III: acute clozapine overdose (n = 31). Patients were investigated for NT-proBNP level and QTc on admission (day 0) and after 24 h (day 1). All the studied drugs had the ability to induce cardiotoxicity in the form of hypotension and dysrhythmias. Thioridazine and pimozide had potentially serious cardiotoxic effects than clozapine. NT-proBNP levels were elevated significantly in all groups on days 0 and 1 when compared with the reference value and a significant decrease in the same parameter on day 1 when compared with that of day 0 within the same group. QTc showed a significant prolongation in all studied groups on days 0 and 1, and there was a significant shortening of QTc on day 1 when compared with that of day 0 within the same group. A significant positive correlation of NT-proBNP level elevation with QTc prolongation was reported in all groups on days 0 and 1. Serious dysrhythmias were associated with QTc prolongation greater than 500 ms. And it was concluded that NT-proBNP, in adjunction with QTc measurement, may be a valuable and sensitive laboratory biomarker to predict cardiotoxicity of antipsychotic overdose. Larger multicenter studies are still needed to verify this possible relationship.

Topics: Adolescent; Adult; Antipsychotic Agents; Arrhythmias, Cardiac; Biomarkers; Drug Monitoring; Drug Overdose; Early Diagnosis; Egypt; Electrocardiography; Female; Heart Conduction System; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Time Factors; Young Adult

Topics: Acute Disease; Drug Approval; Dyspnea; Heart Failure; Humans; Hypotension; Natriuretic Agents; Natriuretic Peptide, Brain; Treatment Outcome

Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis and thus reduce the patients' life expectancy. The aim of this study was to assess the link between left-ventricular diastolic dysfunction and dialytic hypotension.. We performed a prospective cross-sectional study of 72 hemodialysis patients with a low dialysis vintage, 36 of whom had dialysis hypotension, based on echocardiography and brain natriuretic peptide (BNP) assay.. There was no difference between normotensive patients and those with dialysis-associated chronic hypotension as regards BNP level, cardiac index, left-ventricular ejection fraction, or myocardial fractional shortening. Both hypotension-prone patients requiring dialysate sodium profiling and chronic refractory hypotensive patients requiring macromolecule infusion had cardiac diastolic dysfunction as shown by a similarly abnormal E/A ratio <1 in 89-91% of cases, associated with a significant decrease in color M-mode diastolic flow propagation velocity (V(p), p < 0.05 nonparametric ANOVA). The area under the ROC curve for V(p) was 0.69. A V(p) cutoff of 39.5 cm/s was optimal for predicting dialysis-associated hypotension.. We conclude that diastolic dysfunction is associated with dialytic hypotension and that a low V(p)--a preload-independent index--is predictive of dialysis-associated hypotension.

Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Comorbidity; Confidence Intervals; Cross-Sectional Studies; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Failure, Diastolic; Humans; Hypotension; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Renal Dialysis; Risk Assessment; ROC Curve; Severity of Illness Index; Sex Distribution; Survival Rate; Ventricular Dysfunction, Left

Hypotension has been proposed as the cause of nesiritide-associated increases in serum creatinine (SCr); however, this hypothesis has not been tested.. This retrospective evaluation of patients who had a pulmonary artery catheter and received nesiritide in the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial assessed hypotension, SCr elevation, concomitant therapy, and mortality. Patients were categorized by baseline pulmonary capillary wedge pressure (PCWP) and analyzed both for overall population and by diuretic dose.. Compared with patients with PCWP > 23 mm Hg (n = 105), patients with PCWP < or = 23 mm Hg (n = 49) had more hypotension within 24 hours of initiating nesiritide (16% vs 7%), but neither more SCr elevation by nominal day 30 (29% vs 28%) nor higher mortality (30 days: 8.2% vs 7.7%; 6 months: 29.0% vs 29.3%). The risk of hypotension was directly related to high dose diuretics (25% vs 6%; relative risk [RR]: 4.2; 95% confidence interval [CI]: 1.10-15.82) and was not significantly increased in patients without this concomitant treatment (10% vs 7%; RR: 1.4; 95% CI: 0.34-5.93). Additionally, high dose diuretics significantly increased the risk of SCr elevation (RR: 2.6; 95% CI: 1.03-6.64) and 6 month mortality (hazard ratio: 3.6; 95% CI: 1.19-10.63) in patients with PCWP < or = 23 mm Hg.. Hypotension is not the primary etiology for nesiritide-associated increases in SCr. High dose diuretics increase the risk of adverse outcomes in patients with PCWP < or = 23 mm Hg and should be reserved for patients in whom PCWPs are known to be markedly elevated.

Topics: Acute Disease; Aged; Biomarkers; Catheterization, Swan-Ganz; Creatinine; Diuretics; Double-Blind Method; Drug Therapy, Combination; Female; Heart Failure; Hemodynamics; Humans; Hypotension; Kaplan-Meier Estimate; Male; Middle Aged; Multicenter Studies as Topic; Natriuretic Peptide, Brain; Patient Selection; Prospective Studies; Pulmonary Wedge Pressure; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Treatment Outcome; Up-Regulation; Vasodilator Agents

Though brain natriuretic peptide (BNP) is widely used as a clinical marker of cardiac function, there is considerable confusion in the interpretation of its value in hemodialysis (HD) patients whose BNPs are often elevated without cardiac diseases. The aim of the present study is to examine the predictive value of BNP for blood pressure (BP) fall during HD and cardiac function.. Subjects consisted of 205 (160 males, 45 females; age 66.5 +/- 10.5 years) consecutive uremic patients requiring maintenance HD who were admitted to our hospital during 2001-2004. One hundred and eleven cases had a history of ischemic heart disease. We measured BNP in all cases and collected clinical data including age, sex, duration of HD, blood examination and echocardiography.. BNP of all 205 cases ranged from 6 to 16,097 pg/ml (median 831). During HD, the average BP change was -24.5 +/- 20.5 mm Hg, and 111 cases showed a systolic BP reduction >20 mm Hg. BNP did not predict the degree of BP fall. After adjusting confounding factors, the presence of ischemic heart disease, ultrafiltration rate, systolic BP before HD and serum sodium concentration showed a significant correlation with BP change (t = -2.84, -2.76, -4.68 and 2.90; p = 0.005, <0.01, <0.0001 and <0.005, respectively). In relation to echocardiographic indices, BNP >785 pg/ml could predict left ventricular dysfunction (fractional shortening of the left ventricle <30%, sensitivity 73%, specificity 65%).. The level of BNP could not predict BP fall during HD. However, BNP is a good indicator of cardiac function even in uremic patients.

Topics: Aged; Biomarkers; Female; Heart Diseases; Humans; Hypotension; Kidney Failure, Chronic; Linear Models; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Renal Dialysis; ROC Curve; Sensitivity and Specificity; Ultrasonography; Uremia

Topics: Female; Humans; Hypotension; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardium; Natriuretic Agents; Natriuretic Peptide, Brain; Randomized Controlled Trials as Topic; Receptors, Atrial Natriuretic Factor

In addition to haemodynamic actions, Ucn1 (urocortin 1) has been reported to affect a number of hormonal systems; however, it remains unclear whether Ucn1 modulates circulating hormones under physiological conditions. Accordingly, in the present study, we have examined the effects of Ucn1 on haemodynamics, hormones and renal indices in normal conscious sheep subjected to a nitroprusside-induced hypotensive stimulus designed to alter hormonal levels within the physiological range. Ucn1 administration did not alter the haemodynamic response to nitroprusside-induced hypotension. However, compared with the rise observed on the control day, plasma ANP (atrial natriuretic peptide; P=0.043), BNP (brain natriuretic peptide; P=0.038) and endothelin-1 (P=0.011) levels were reduced following Ucn1 administration. Associated with this significant reduction in natriuretic peptides, the increase in urinary sodium output associated with rising pressures post-nitroprusside was abolished following Ucn1 administration (P=0.048). Ucn1 had no significant effect on the response of hormones of the renin-angiotensin-aldosterone system or the hypothalamo-pituitary-adrenal axis. In conclusion, Ucn1, administered at physiologically relevant levels during nitroprusside-induced hypotension, attenuates the secretion/release of endothelin-1 and the cardiac natriuretic peptides ANP and BNP. Suppression of ANP and BNP probably led to an attenuated natriuretic response to recovery from acute hypotension. The threshold for the action of Ucn1 on the natriuretic peptides and endothelin-1 appears to be below that of other actions of Ucn1.

Topics: Aldosterone; Angiotensin II; Animals; Antihypertensive Agents; Atrial Natriuretic Factor; Blood Pressure; Cardiac Output; Corticotropin-Releasing Hormone; Cyclic GMP; Heart Rate; Hypotension; Natriuretic Peptide, Brain; Nitroprusside; Sheep; Urocortins

Hypotension during hemodialysis (HD) is an important problem in patients on HD. To investigate the risk factors that contribute to the hypotension during HD, we compared background factors of hypotensive (HP) patients during HD. Among 58 patients undergoing HD in Tamura Memorial Hospital, 12 patients could not continue full HD because of hypotension. We compared the data of ultrafiltration volume, cardiothoracic ratio (CTR), total protein (TP), serum albumin, blood urea nitrogen (BUN), serum creatinine, total cholesterol (TC), hemoglobin (Hb), blood glucose (BS), brain natriuretic peptide (BNP), and cardiac function between HP patients (HP group; n=12) and sex- and age-matched control patients (NP group; n=12). There were no significant differences of age, sex, and duration of HD between the 2 groups. Cardiothoracic ratio is bigger and BNP is higher in the HP group compared with the NP group (CTR: HP 55.8+/-2.9% vs. NP 47.7+/-1.1%, p=0.0165; BNP: HP 602+/-171 vs. NP 147+/-38, p=0.0167). Serum albumin in the HP group is significantly lower compared with the NP group (HP 3.2+/-0.1 g/dL vs. NP 3.5+/-0.1 g/dL, p=0.0130). However, there were no significant differences of ultrafiltration rate (UFR), BS, TC, Hb, and cardiac function between the 2 groups. There is a significant negative correlation between changes of systolic blood pressure (delta systolic blood pressure) and serum albumin in these patients (r=-0.598, p=0.0016). From these data, we conclude that hypoalbuminemia is a major risk factor of hypotension during HD.

Topics: Aged; Biomarkers; Blood Pressure; Blood Urea Nitrogen; Cholesterol; Creatinine; Echocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypoalbuminemia; Hypotension; Kidney Failure, Chronic; Male; Natriuretic Peptide, Brain; Prognosis; Renal Dialysis; Retrospective Studies; Risk Factors; Serum Albumin; Ventricular Function, Left

Topics: Adult; Aged; Blood Pressure; Cardiotonic Agents; Drug Synergism; Drug Therapy, Combination; Female; Heart Failure; Humans; Hypotension; Male; Medical Records; Middle Aged; Milrinone; Natriuretic Agents; Natriuretic Peptide, Brain; Prospective Studies; Pulmonary Wedge Pressure

Acute hypotension, transient hypoxaemia and elevation of pulmonary artery pressure are well known to occur during cemented arthroplasty. The aim of this prospective clinical study was to characterize the relationship between plasma concentrations of atrial and brain natriuretic peptides (ANP, BNP), and changes in blood pressure in patients undergoing hip arthroplasty. Elevated ANP and BNP levels may be markers of inadequate myocardial reserve. We measured plasma ANP and BNP levels before the operation and 20 minutes after the cementing in 18 patients (54-90 yr). We defined a hypotensive response after cementing as a decrease in systolic blood pressure of more than 15 mm Hg below the pre-cementing value. In the hypotensive group, preoperative values of ANP were 123 +/- 48.5 pg/ml and BNP, 138 +/- 71.7 pg/ml. These values are significantly greater than those in the normotensive group (ANP 35.9 +/- 7.7, and BNP 17.2 +/- 3.2 pg/ml). High preoperative values of ANP and BNP are associated with more hypotension during cemented arthroplasty and could provide an indication of which patients are at risk of this complication.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Anesthesia, Intravenous; Anesthetics, Combined; Arthroplasty, Replacement, Hip; Atrial Natriuretic Factor; Biomarkers; Blood Pressure Determination; Bone Cements; Female; Follow-Up Studies; Hemodynamics; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Perioperative Care; Probability; Propofol; Sensitivity and Specificity

Natrecor (nesiritide) is targeted to acute decompensating CHF patients.

Topics: Atrial Natriuretic Factor; Cardiotonic Agents; Drug Costs; Dyspnea; Heart Failure; Hospitalization; Humans; Hypotension; Natriuretic Peptide, Brain; United States

Topics: Atrial Natriuretic Factor; Cardiotonic Agents; Half-Life; Heart Failure; Humans; Hypotension; Multicenter Studies as Topic; Natriuretic Peptide, Brain; Randomized Controlled Trials as Topic

The pharmacological activities of synthetic mammalian brain natriuretic peptides (BNP) from the human, pig and rat were examined in rats. These peptides all elicited diuresis and hypotension, relaxed isolated rat aorta, augmented cyclic GMP concentration in cultured rat vascular smooth muscle cells, and bound to the cells with a high affinity. Pig and rat BNPs were as active as atrial natriuretic peptides from the human and the rat (alpha-hANP and alpha-rANP) for the diuretic and hypotensive effects as well as for cyclic GMP augmentation, while human BNP was about 10 times less potent. Rat BNP was not as active as the other peptides in competing with the binding of [125I]alpha-hANP to rat vascular smooth muscle cells. Thus, the BNPs did not have identical pharmacological profiles although the potencies of the peptides for cyclic GMP augmentation correlated well to those for vasorelaxation.

Topics: Amino Acid Sequence; Animals; Atrial Natriuretic Factor; Binding, Competitive; Brain; Cells, Cultured; Cyclic GMP; Diuretics; Humans; Hypotension; Male; Molecular Sequence Data; Muscle Relaxation; Muscle, Smooth, Vascular; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Rats; Rats, Inbred Strains; Recombinant Proteins; Swine