Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial

OBJECTIVE: We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure. METHODS: We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction <0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov: NCT01857999. RESULTS: We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg.min, indexed systemic vascular resistance 1918.0 dynes.sec/cm5.m2, cardiac index 2.8 L/min.m2, and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, -49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements. CONCLUSION: Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence. .

Augentation of plasma atrial natriuretic peptide by hot water immersion in normal man / 日本温泉気候物理医学会雑誌

This study examined acute effects of hot water immersion on the secretion of human alpha-atrial natriuretic peptide (ANP), cyclic GMP (c-GMP), arginine vasopressin (AVP), plasma renin activity (PRA) and aldosterone in venous blood. Ten healthy subjects (mean age: 20.5yr.) underwent hot water immersion (IM) of 40°C for ten minutes by quiet sitting, which simulates usual bathing among Japanese. ANP rose from 19 to 34pg/ml with the peaked value at ten minutes of IM (p<0.001), and remained signifcantly elevated during 10 to 30 minutes after IM. Then they qradually returned to the pre-immersing level by 50min. c-GMP showed similar timed responeses as ANP. Between those parameters significantly positive linear correlation (p<0.001) was observed. AVP did not change immediately after IM, but tended to rise at 20 minutes after IM. PRA and aldosterone increased in rates of the changes later at 15 to 30 minutes, but less significantly as ANP. Those results suggested that the secretion of ANP by water immersion was enhanced by thermal stimuli in spite of short duration of central hypervolemia by water immersion. Suppressing effects of water immersion on AVP and renin-aldosterone system were small. On the contrary, hot water stimuli exerted rebounding increases on them. c-GMP seemed to be one of the indicative factors relating to the change of ANP.