Real-Life Use of Neurohormonal Antagonists and Loop Diuretics in Chronic Heart Failure: Analysis of Serial Biomarker Measurements and Clinical Outcome

Autor: Nick van Boven, Kadir Caliskan, Isabella Kardys, Jasper J. Brugts, Victor A. Umans, Milos Brankovic, K. Martijn Akkerhuis, Olivier C. Manintveld, Tjeerd Germans, Alina A. Constantinescu
Přispěvatelé: Cardiology
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Time Factors
Health Status
medicine.medical_treatment
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
urologic and male genital diseases
Biomarkers
Pharmacological
Angiotensin Receptor Antagonists
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Sodium Potassium Chloride Symporter Inhibitors
Predictive Value of Tests
Internal medicine
medicine
Humans
Pharmacology (medical)
Longitudinal Studies
Prospective Studies
030212 general & internal medicine
Aged
Netherlands
Aged
80 and over
Heart Failure
Pharmacology
Creatinine
Ejection fraction
Troponin T
biology
business.industry
Angiotensin-converting enzyme
Middle Aged
medicine.disease
Treatment Outcome
Endocrinology
chemistry
Cystatin C
Heart failure
Chronic Disease
Disease Progression
biology.protein
Cardiology
Biomarker (medicine)
Female
Drug Monitoring
Diuretic
business
Zdroj: Clinical Pharmacology & Therapeutics, 104(2), 346-355. Wiley-Blackwell
ISSN: 0009-9236
DOI: 10.1002/cpt.931
Popis: We determined the temporal effects of neurohormonal antagonists and loop diuretics on serially assessed (3-monthly) cardiorenal biomarkers, functional status, and clinical outcomes in 250 patients with chronic heart failure (CHF) with reduced ejection fraction. In blood, we measured NT-proBNP, troponin T, C-reactive protein, creatinine, cystatin C; in urine, N-acetyl-beta-d-glucosaminidase and kidney-injury-molecule-1. Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) were inversely associated with cardiac impairment, inflammation, and renal tubular damage, but not with glomerular dysfunction. Diuretics were associated with worse biomarker profiles and with a hazard ratio for adverse clinical outcome of 1.12 (95% confidence interval: 1.03-1.22) per 40 mg higher doses. ACE-inhibitors/ARBs were more frequently downtitrated and diuretics more frequently uptitrated in patients who experienced endpoints than in those who did not. In conclusion, a decrease or withholding of ACE-inhibitors/ARBs solely based on glomerular function is not justified because of the beneficial effects on the heart, inflammation, and renal tubules. Higher and increased diuretic doses mark progression towards endstage CHF.
Databáze: OpenAIRE
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