Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide.
BACKGROUND: B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence. AIM: To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of un...
| Main Authors: | , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2008
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| _version_ | 1826274920847376384 |
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| author | Mant, D Hobbs, F Glasziou, P Wright, L Hare, R Perera, R Price, C Cowie, M |
| author_facet | Mant, D Hobbs, F Glasziou, P Wright, L Hare, R Perera, R Price, C Cowie, M |
| author_sort | Mant, D |
| collection | OXFORD |
| description | BACKGROUND: B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence. AIM: To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients. DESIGN OF STUDY: Screening study with single-arm intervention. SETTING: A total of 1918 patients with diabetes mellitus or ischaemic heart disease aged > or =65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration. METHOD: Eligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration of <36 pmol/l. RESULTS: Seven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (P<0.001). The most effective therapeutic step was a switch in beta-blocker to carvedilol or bisoprolol (P<0.001). CONCLUSION: About 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced. |
| first_indexed | 2024-03-06T22:50:50Z |
| format | Journal article |
| id | oxford-uuid:5eb7453f-b424-4ca1-8993-0ad21f687d49 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:50:50Z |
| publishDate | 2008 |
| record_format | dspace |
| spelling | oxford-uuid:5eb7453f-b424-4ca1-8993-0ad21f687d492022-03-26T17:42:26ZIdentification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5eb7453f-b424-4ca1-8993-0ad21f687d49EnglishSymplectic Elements at Oxford2008Mant, DHobbs, FGlasziou, PWright, LHare, RPerera, RPrice, CCowie, M BACKGROUND: B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence. AIM: To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients. DESIGN OF STUDY: Screening study with single-arm intervention. SETTING: A total of 1918 patients with diabetes mellitus or ischaemic heart disease aged > or =65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration. METHOD: Eligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration of <36 pmol/l. RESULTS: Seven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (P<0.001). The most effective therapeutic step was a switch in beta-blocker to carvedilol or bisoprolol (P<0.001). CONCLUSION: About 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced. |
| spellingShingle | Mant, D Hobbs, F Glasziou, P Wright, L Hare, R Perera, R Price, C Cowie, M Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. |
| title | Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. |
| title_full | Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. |
| title_fullStr | Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. |
| title_full_unstemmed | Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. |
| title_short | Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. |
| title_sort | identification and guided treatment of ventricular dysfunction in general practice using blood b type natriuretic peptide |
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