Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure: A double-blind, placebo-controlled, randomized crossover trial

Background: The pharmacological effects of infusion of human brain natriuretic peptide (hBNP) in patients with severe congestive heart failure have not been characterized previously. Methods and Results: Twenty patients with severe congestive heart failure were randomized in a double-blind, placebo-controlled, crossover trial to receive incremental 90-minute infusions of hBMP (0.003, 0.01, 0.03, and 0.1 μg/kg per minute) or placebo on 2 consecutive days. At the highest completed dose of the hBNP, mean pulmonary artery pressure decreased from 38.3±1.6 to 25.9±1.7 mm Hg; mean pulmonary capillary wedge pressure decreased from 25.1±1.1 to 13.2±1.3 mm Hg; mean right atrial pressure decreased from 10.9±1 to 4.8±1.0 mm Hg: mean arterial pressure decreased from 85.2±2.0 to 74.9±1.7 mm Hg; and cardiac index increased from 2.0±0.1 to 2.5±0.1 L/min per square meter (all P<.01 versus placebo). Urine volume and urine sodium excretion increased significantly during hBNP infusion when compared with placebo infusion (90±38 versus 67±27 mL/h and 2.6±2.4 versus 1.4±1.2 mEq/h, respectively, both P<.05 versus placebo), whereas creatinine clearance and urinary potassium excretion did not change. Conclusions: Infusion of incremental doses of hBNP is associated with favorable hemodynamic and natriuretic effects in patients with severe congestive heart failure.