Premium
Real‐Life Use of Neurohormonal Antagonists and Loop Diuretics in Chronic Heart Failure: Analysis of Serial Biomarker Measurements and Clinical Outcome
Author(s) -
Brankovic Milos,
Akkerhuis K. Martijn,
Boven Nick,
Manintveld Olivier,
Germans Tjeerd,
Brugts Jasper,
Caliskan Kadir,
Umans Victor,
Constantinescu Alina,
Kardys Isabella
Publication year - 2018
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.931
Subject(s) - medicine , heart failure , renal function , cystatin c , biomarker , hazard ratio , diuretic , creatinine , cardiology , ejection fraction , cardiorenal syndrome , angiotensin converting enzyme , ace inhibitor , endocrinology , confidence interval , blood pressure , biochemistry , chemistry
We determined the temporal effects of neurohormonal antagonists and loop diuretics on serially assessed (3‐monthly) cardiorenal biomarkers, functional status, and clinical outcomes in 250 patients with chronic heart failure (CHF) with reduced ejection fraction. In blood, we measured NT‐proBNP, troponin T, C‐reactive protein, creatinine, cystatin C; in urine, N‐acetyl‐beta‐ d ‐glucosaminidase and kidney‐injury‐molecule‐1. Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) were inversely associated with cardiac impairment, inflammation, and renal tubular damage, but not with glomerular dysfunction. Diuretics were associated with worse biomarker profiles and with a hazard ratio for adverse clinical outcome of 1.12 (95% confidence interval: 1.03–1.22) per 40 mg higher doses. ACE‐inhibitors/ARBs were more frequently downtitrated and diuretics more frequently uptitrated in patients who experienced endpoints than in those who did not. In conclusion, a decrease or withholding of ACE‐inhibitors/ARBs solely based on glomerular function is not justified because of the beneficial effects on the heart, inflammation, and renal tubules. Higher and increased diuretic doses mark progression towards endstage CHF.