N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts the cardio-renal response to aliskiren in patients with type 2 diabetes at high renal and cardiovascular risk

被引：16

作者：

Idzerda, Nienke M. A. ^{[1
]}

Persson, Frederik ^{[2
]}

Pena, Michelle J. ^{[1
]}

Brenner, Barry M. ^{[3
,4
]}

Brunel, Patrick ^{[5
]}

Chaturvedi, Nish ^{[6
]}

McMurray, John J. ^{[7
]}

Parving, Hans-Henrik ^{[8
]}

de Zeeuw, Dick ^{[1
]}

Heerspink, Hiddo J. L. ^{[1
]}

机构：

[1] Univ Groningen, Univ Med Ctr Groningen Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands

[2] Steno Diabet Ctr Copenhagen, Copenhagen, Denmark

[3] Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA

[4] Harvard Med Sch, Boston, MA USA

[5] Pharma AG, Novartis, Basel, Switzerland

[6] UCL, Inst Cardiovasc Sci, London, England

[7] Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

[8] Univ Copenhagen, Rigshosp, Dept Med Endocrinol, Copenhagen, Denmark

来源：

DIABETES OBESITY & METABOLISM | 2018年 / 20卷 / 12期

关键词：

cardiovascular disease; clinical trial; diabetes complications; type; 2; diabetes; POST-HOC ANALYSIS; ANGIOTENSIN RECEPTOR BLOCKADE; DIETARY-SODIUM RESTRICTION; HEART-FAILURE; BLOOD-PRESSURE; END-POINTS; HYDROCHLOROTHIAZIDE; ALBUMINURIA; NEPHROPATHY; REDUCTION;

D O I：

10.1111/dom.13465

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Sodium retention and volume overload are the main determinants of poor response to renin-angiotensin-aldosterone system (RAAS) inhibition in patients with diabetes. As volume excess can exist without symptoms, biomarkers are needed to identify a priori which patients are volume overloaded and may experience less benefit from RAAS inhibition. N-terminal pro-brain natriuretic peptide (NT-proBNP) is released in the setting of increased cardiac wall stress and volume overload. We conducted a post hoc analysis among 5081 patients with type 2 diabetes mellitus participating in the ALTITUDE trial to investigate whether NTproBNP can predict the effects of additional therapy with aliskiren on cardio-renal endpoints. Aliskiren compared to placebo reduced the risk of the primary cardio-renal endpoint events by 20% (95% confidence interval [CI] 16 to 61) and 2% (95% CI -42 to 30) in the two lowest NT-proBNP tertiles, and it increased the risk by 25% (95% CI -4 to 96) in the highest NT-proBNP tertile (P value for trend = 0.009). Similar trends were observed for the cardiovascular and end-stage renal disease endpoints. Effects of aliskiren compared to placebo on safety outcomes (hyperkalaemia and hospitalization for acute kidney injury) were independent of NT-proBNP. In conclusion, baseline NT-proBNP may be used as a marker to predict the response to aliskiren with regard to cardio-renal outcomes when added to standard therapy with RAAS inhibition.

引用

页码：2899 / 2904

页数：6

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