Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure - A double-blind, placebo-controlled, randomized crossover trial

Background The pharmacological effects of infusion of human brain natriuretic peptide (nBNP) in patients with severe congestive heart failure have not been characterized previously. Methods and Results Twenty patients with seven congestive heart failure were randomized in a double-blind, placebo-controlled, crossover trial to receive incremental 90-minute infusions of hBNP (0.003, 0.01, 0.03, and 0.1 mu g/kg per minute) or placebo on 2 consecutive days. At the highest completed dose of the hBNP, mean pulmonary artery pressure decreased from 38.3+/-1.6 to 25.9+/-1.7 mm Hg, mean pulmonary capillary wedge pressure decreased from 25.1+/-1.1 to 13.2+/-1.3 mm Hg; mean right atrial pressure decreased from 10.9+/-1 to 4.8+/-1.0 mm Hg; mean arterial pressure decreased from 85.2+/-2.0 to 74.9+/-1.7 mm Hg; and cardiac index increased from 2.0+/-0.1 to 2.5+/-0.1 L/min per square meter (all P<.01 versus placebo. Urine volume and urine sodium excretion increased significantly during hBNP infusion when compared with placebo infusion (90+/-38 versus 67+/-27 mL/h and 2.6+/-2.4 versus 1.4+/-1.2 mEq/h, respectively, both P<.05 versus placebo), whereas creatinine clearance and urinary potassium excretion did net change. Conclusions Infusion of incremental doses of hBNP is associated with favorable hemodynamic and natriuretic effects in patients with severe congestive heart failure.