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The Efficacy of Different Therapy Protocols for Heart Failure in Patients with Heart Failure and Increased Natriuretic Peptide Level Natriuretic peptide BNP might be clinically useful for monitoring treatment effects in patients with heart failure (HF). In order to investigate the pharmacological effects of different therapy protocols for patients with HF based on the BNP level before and after therapy, we performed an open randomized comparative trial. Sixty-two HF patients with increased natriuretic peptide level, aged 55.82±9.09, II-III NYHA functional classes, ejection fraction (EF) <45%, received a 12-week treatment with either traditional pharmacotherapy for HF with ACE inhibitors and β-blockers (1st group), or ACE inhibitors and angiotensin II receptor blockers (ARBs) (2nd group), or β-blockers and ARBs (3rd group), and ACE inhibitors, β-blockers and ARBs (4th group). We evaluated the BNP plasma level, hemodynamic state (pulmonary capillary wedge pressure (PCWP), cardiac output (CO), EF and exercise capacity. The BNP plasma level decreased significantly in the 4th group of patients who received ACE inhibitors, β-blockers and ARBs, in comparison to other groups. A beneficial influence on hemodynamic and exercise capacity was significantly pronounced in this group, compared to the other therapy regimes. In conclusion, the therapeutic protocol: ACE inhibitors, β-blockers and ARBs in HF patients with increased natriuretic peptide level significantly improves the quality of life, left ventricular function, hemodynamic parameters and exercise capacity. All these changes were accompanied with a decreasing of the BNP plasma level. Efikasnost Različitih Terapijskih Protokola ZA Srčanu Insuficijenciju Kod Pacijenata SA Srčanom Insuficijencijom I Povišenim Nivoom Natriuretskih Peptida Natriuretski peptidi mogu imati klinički značaj u praćenju terapijskih efekata kod pacijenata sa srčanom insuficijencijom. Cilj ove randomizovane studije bio je da se ispita efikasnost različitih terapijskih protokola za srčanu insuficijenciju kod pacijenata sa srčanom insuficijencijom na osnovu nivoa BNP-a u plazmi pre i posle terapije. Šezdeset dva pacijenta sa srčanom insuficijencijom i povišenim nivoom BNP-a, dobi 55,82±9,09 god, sa II-III NYHA funkcionalnom klasom, ejekcionom frakcijom (EF) <45%, primali su 12 nedelja tradicionalnu farmakološku terapiju za srčanu insuficijenciju, i to: ACE inhibitore i β blokatore (1. grupa); ACE inhibitore i angiotenzin II receptor blokatore (ARBs) (2. grupa); ß blokatore i ARBs (3. grupa); ACE inhibitore, ß blokatore i ARBs (4. grupa). Ispitivali smo nivo BNP-a u plazmi, hemodinamske parametre (pritisak u plućnim kapilarima (PCWP), cardiac output (CO), EF i dužinu trajanja opterećenja. Nivo BNP-a u plazmi se značajno snizio u 4. grupi pacijenata, koji su bili na ACE inhibitorima, ß blokatorima i ARBs, u odnosu na ostale grupe. Takođe je primećen značajan pozitivan uticaj na hemodinamske parametre i trajanje opterećenja u toj grupi pacijenata, u poređenju sa ostalim ispitanicima. Može se zaključiti da terapijski protokol koji uključuje ACE inhibitore, ß blokatore i ARBs kod pacijenata sa srčanom insuficijencijom i povišenim BNP-om značajno poboljšava kvalitet života, funkciju leve komore, vrednosti hemodinamskih parametara i dužinu trajanja opterećenja. Sve te promene su udružene sa sniženjem nivoa BNP-a u plazmi.