Effect of Beta-blockade and ACE Inhibition on B-type Natriuretic Peptides in Stable Patients with Systolic Heart Failure

  • Jens RosenbergEmail author
  • Finn Gustafsson
  • Willem J. Remme
  • Günter A. J. Riegger
  • Per Rossen Hildebrandt



The long-term effect of beta-blockade on the plasma levels of natriuretic peptides BNP and its N-terminal counterpart, NT-proBNP, as risk markers in heart failure (HF) is obscure.


Stable systolic HF patients from the CARMEN study were divided in groups matching their randomised treatment allocation: Carvedilol, enalapril or carvedilol+enalapril. Changes in BNP and NT-proBNP from baseline to 6 months maintenance visit were evaluated in each treatment arm. Furthermore, the prognostic value of BNP and NT-proBNP during monotherapy with carvedilol was assessed with univariate Cox proportional hazards models using a combined endpoint of all cause mortality and cardiovascular hospitalisation.


NT-proBNP and BNP were significantly reduced after six months treatment with enalapril (NT-proBNP 1,303 to 857 pg/ml (P < 0.001), BNP 119 to 85 pg/ml (P < 0.001)) or carvedilol+enalapril (NT-proBNP 1,223 to 953 pg/ml (P = 0.003), BNP 117 to 93 pg/ml (P = 0.01)). In contrast, no change was observed in the carvedilol group (NT-proBNP 907 to 1,082 pg/ml (P = 0.06), BNP 114 to 130 pg/ml (P = 0.15). The prognostic value of NT-proBNP and BNP was maintained in the carvedilol group (NT-proBNP HR 1.018 95% CI (1.005–1.032), BNP 1.171 (1.088–1.260)).


Treatment of HF patients with carvedilol alone does not reduce levels of natriuretic peptides, but treatment with enalapril does. Both BNP and NT-proBNP predict death and hospitalisation in HF patients treated with carvedilol for six months. The clinical implication of our results is that NT-proBNP and BNP can be used as risk markers of death and cardiovascular hospitalisations in systolic HF patients receiving carvedilol without ACE inhibition.

Key words

brain natriuretic peptide adrenergic beta-antagonists carvedilol angiotensin-converting enzyme inhibitors enalapril prognosis congestive heart failure 



The work was funded by a grant from The Danish Heart Foundation.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jens Rosenberg
    • 1
    Email author
  • Finn Gustafsson
    • 2
  • Willem J. Remme
    • 3
  • Günter A. J. Riegger
    • 4
  • Per Rossen Hildebrandt
    • 5
  1. 1.Cardiology DepartmentFrederiksberg University HospitalFrederiksbergDenmark
  2. 2.Cardiology DepartmentRigshospitaletCopenhagenDenmark
  3. 3.Sticares Cardiovascular Research FoundationRhoonThe Netherlands
  4. 4.Department of Internal Medicine 2University of RegensburgRegensburgGermany
  5. 5.Cardiology DepartmentRoskilde County HospitalRoskildeDenmark

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