Real-Life Use of Neurohormonal Antagonists and Loop Diuretics in Chronic Heart Failure: Analysis of Serial Biomarker Measurements and Clinical Outcome

Milos Brankovic, K. Martijn Akkerhuis, Nick van Boven, Olivier Manintveld, Tjeerd Germans, Jasper Brugts, Kadir Caliskan, Victor Umans, Alina Constantinescu, Isabella Kardys

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)346-355
JournalClinical Pharmacology and Therapeutics
Volume104
Issue number2
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

Brankovic, Milos ; Akkerhuis, K. Martijn ; van Boven, Nick ; Manintveld, Olivier ; Germans, Tjeerd ; Brugts, Jasper ; Caliskan, Kadir ; Umans, Victor ; Constantinescu, Alina ; Kardys, Isabella. / Real-Life Use of Neurohormonal Antagonists and Loop Diuretics in Chronic Heart Failure: Analysis of Serial Biomarker Measurements and Clinical Outcome. In: Clinical Pharmacology and Therapeutics. 2018 ; Vol. 104, No. 2. pp. 346-355.
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abstract = "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.",
author = "Milos Brankovic and Akkerhuis, {K. Martijn} and {van Boven}, Nick and Olivier Manintveld and Tjeerd Germans and Jasper Brugts and Kadir Caliskan and Victor Umans and Alina Constantinescu and Isabella Kardys",
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Brankovic, M, Akkerhuis, KM, van Boven, N, Manintveld, O, Germans, T, Brugts, J, Caliskan, K, Umans, V, Constantinescu, A & Kardys, I 2018, 'Real-Life Use of Neurohormonal Antagonists and Loop Diuretics in Chronic Heart Failure: Analysis of Serial Biomarker Measurements and Clinical Outcome' Clinical Pharmacology and Therapeutics, vol. 104, no. 2, pp. 346-355. https://doi.org/10.1002/cpt.931

Real-Life Use of Neurohormonal Antagonists and Loop Diuretics in Chronic Heart Failure: Analysis of Serial Biomarker Measurements and Clinical Outcome. / Brankovic, Milos; Akkerhuis, K. Martijn; van Boven, Nick; Manintveld, Olivier; Germans, Tjeerd; Brugts, Jasper; Caliskan, Kadir; Umans, Victor; Constantinescu, Alina; Kardys, Isabella.

In: Clinical Pharmacology and Therapeutics, Vol. 104, No. 2, 2018, p. 346-355.

Research output: Contribution to journalArticleAcademicpeer-review

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