B-type natriuretic peptides (BNP and PRO-BNP) predict longterm survival in patients with advanced heart failure treated with atenolol.

In heart failure norepinephrine (NE) endothelin (ET), and cardiac natriuretic peptides have prognostic meaning. In 91 heart failure pts (LVEF <25%) on 40 mg enalapril/d and double-blind atenolol (50 − 100 mg/d) vs placebo plasma levels of NE, big ET, N-t-atrial natriuretic peptide, BNP and pro-BNP were measured at month 0, 3, 6, 12 and 24. After the double-blind phase of the original study (mean 395 days) pts were tracked up to 4 years when 60 pts were still alive, while 31 pts (atenolol group 10 pts, placebo group 21 pts) had died from a cardiovascular cause. Initial BNP levels by outcome were 38+6 vs 74+13 fmol/ml in the atenolol group and 21+6 vs 85+21 fmol/ml in the placebo group. Stepwise multivariate Cox analysis was performed before and during study (incorporating the last values prior to death and in survivors the last available hormone level, NYHA class and LVEF within or at mo 24). Before study, log BNP plasma level (x2=13.9, p=0.0002), treatment allocation, (x2=9.5, p=0.002) and LVEF (x2=5.6, p=0.017) were independently related to mortality. During study log BNP plasma level (x2=21.3, p=0.0001) LFEV (x2=11.2, p=0.0008) and treatment allocation (x2=6.4, p=0.0109) retained their predictive value, while log pro BNP (x2=8.9, p=0.0027) provided additional prognostic information. Repetitive proBNP levels by outcome were 160+28 vs 475+65 fmol/ml in the atenolol group and 210+49 vs 421+42 fmol/ml in the placebo group.