Skip to main content
Log in

B-Type Natriuretic Peptide: Spectrum of Application. Nesiritide (Recombinant BNP) for Heart Failure

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

The therapeutic goals for patients hospitalized with acutely decompensated heart failure are to reverse acute hemodynamic abnormalities, relieve symptoms, and to initiate heart failure therapies which will decrease disease progression and improve long-term survival. Nesiritide (recombinant B-type natriuretic peptide) is the first in a new class of therapeutic agents for the treatment of heart failure and has been demonstrated to offer a unique combination of safety and efficacy. The use of nesiritide on top of standard care including diuretic therapy, has been proven to lead to meaningful clinical benefits in a broad range of acutely decompensated heart failure patients. Nesiritide is an attractive therapeutic option because of its more rapid and sustained hemodynamic profile, more favorable effects on neurohormonal suppression, with less adverse effects than alternative intravenous heart failure treatments such as nitroglycerine, nitroprusside, dobutamine, or milrinone. The use of nesiritide is the most effective initial treatment approach among currently available strategies to reverse acutely decompensated heart failure and to facilitate optimization of the heart failure medical regimen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998;339:321–328.

    Google Scholar 

  2. Rayburn BK, Bourge BC. Nesiritide: A unique therapeutic cardiac peptide. Rev Cardiovasc Med 2001;2:S25–S31.

    Google Scholar 

  3. Chen HH, Burnett JC. Natriuretic peptides in the pathophysiology of congestive heart failure. Curr Cardiol Rep 2000;2:198–205.

    Google Scholar 

  4. Zellner C, Protter AA, Ko E, et al. Coronary vasodilator effects of BNP: Mechanisms of action in coronary conductance and resistance arteries. Am J Physiol 1999;276:H1049–H1057.

    Google Scholar 

  5. Marcus LS, Hart D, Packer M, et al. Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure.Adoubleblind, placebo-controlled, randomized crossover trial. Circulation 1996;94:3184–3189.

    Google Scholar 

  6. Fonarow GC. Pharmacologic therapies for acutely decompensated heart failure. Rev Cardiovasc Med 2002;3:S18–S27.

    Google Scholar 

  7. Abraham WT, Lowes BD, Ferguson DA, et al. Systemic hemodynamic, neurohormonal, and renal effects of a steady-state infusion of human brain natriuretic peptide in patients with hemodynamically decompensated heart failure. J Card Failure1998;4:37–44.

    Google Scholar 

  8. Hobbs RE, Miller LW, Bott-Silverman C, et al. Hemodynamic effects of a single intravenous injection of synthetic human brain natriuretic peptide in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1996;78:896–901.

    Google Scholar 

  9. Colucci WS, Elkayam U, Horton DP, et al. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group. N Engl J Med 2000;343:246–253.

    Google Scholar 

  10. VMAC Investigators. Intravenous nesiritide vs. nitroglycerin for treatment of decompensated congestive heart failure: A randomized controlled trial. JAMA 2002;287:1531–1540.

    Google Scholar 

  11. Silver MA, Horton DP, Ghali JK, et al. Effect of nesiritide versus dobutamine on short-term outcomes in the treatment of patients with acutely decompensated heart failure. J Am Coll Cardiol 1997;39:798–803.

    Google Scholar 

  12. Burger AJ. Elkayam U, Neibaur MT, et al. Comparison of the occurrence of ventricular arrhythmias in patients with acutely decompensated congestive heart failure receiving dobutamine versus nesiritide therapy. Am J Cardiol 2001;88:35–39.

    Google Scholar 

  13. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, et al. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. J Am Coll Cardiol 2001;38:2101–2113.

    Google Scholar 

  14. Fonarow GC, Stevenson LW, Walden JA, et al. Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol 1997;30:725–733.

    Google Scholar 

  15. Altschul LA, Masciello, Massaro G. Nesiritide in an outpatient infusion clinic setting—case studies of 17 patients. J Card Failure 2002;8:S56.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fonarow, G.C. B-Type Natriuretic Peptide: Spectrum of Application. Nesiritide (Recombinant BNP) for Heart Failure. Heart Fail Rev 8, 321–325 (2003). https://doi.org/10.1023/A:1026170228469

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1026170228469

Navigation