Probrain Natriuretic Peptide for assessment of efficacy in heart failure treatment

Özkara, Adem; Turgut, Faruk; Selçoki, Yusuf; Karanfil, Aydın; Metin, Melike Ruşen; Kanbay, Mehmet; Tekin, Oğuz; Akçay, Ali

doi:10.1007/bf02877769

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…In the subset analysis of the EPHESUS, eplerenone had a similar adverse effect profile to placebo, with the exception of increased incidence of hyperkalemia (serum potassium Ն6.0 mmol/L; 1.7-fold) in hospitalized patient groups with a mean age of Ͼ65 years (59). Although not primarily designed as studies of elderly patients, several other studies that included patients who were a mean age of Ն65 years showed that use of spironolactone or eplerenone in this older population was tolerated and safe (55,60,61).…”

Section: Aldosterone Antagonistsmentioning

confidence: 99%

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Turgut¹,

Balogun²,

Abdel‐Rahman³

2010

Clinical Journal of the American Society of Nephrology

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The proportion of the population that is elderly (age >65 years) is growing across the world. The increasing longevity of humans results in a higher number of elderly patients' presenting with multiple chronic diseases such as hypertension, diabetes, and chronic kidney disease (CKD). These problems increase morbidity and mortality in the elderly. Overactivity of the renin-angiotensin-aldosterone system (RAAS) is associated with the development of hypertension, cardiovascular events, and CKD, so targeting the RAAS is a logical therapeutic approach. Elderly patients present special concerns regarding the benefits versus risks of using RAAS blockers. Plasma renin activity declines with age, which has been attributed to the effect of age-associated nephrosclerosis. Plasma aldosterone is also reduced with age, resulting in a greater risk for hyperkalemia in older individuals, especially when coupled with the age-associated decline in GFR. Moreover, the elderly have a higher frequency of concurrent conditions and are on many medications, which may further increase the risk for adverse effects of RAAS blocking agents. Unfortunately, there is a paucity of literature that is specifically aimed at studying elderly using the RAAS blockers. We present in our in-depth review data regarding benefits and limitations of the use of the RAAS blockades on the various sites along the RAAS pathway for elderly patients. Specific attention was given to the role of combination RAAS blockade therapy and higher monotherapy dosing in the treatment of hypertension in the elderly.

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Section: Aldosterone Antagonistsmentioning

confidence: 99%

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Turgut¹,

Balogun²,

Abdel‐Rahman³

2010

Clinical Journal of the American Society of Nephrology

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“…In 10 out of 18 trials, patients were seen by a specialist at a clinic (Anguita et al 2010;Berger et al 2010;Eurlings et al 2010;Januzzi et al 2011;Jourdain et al 2007;Lainchbury et al 2009;Murdoch et al 1999;Persson et al 2010;Schou et al 2013;Shah et al 2011;Troughton et al 2000). Most patients were randomized once heart Karlstrom et al 2011;Murdoch et al 1999;Ozkara et al 2007;Persson et al 2010;Schou et al 2013;Shah et al 2011;Stienen et al 2018;Troughton et al 2000). The remainder of the trials combined patients with preserved and reduced ejection fraction (Anguita et al 2010;Berger et al 2010;Carubelli et al 2016;Eurlings et al 2010;Lainchbury et al 2009;Maeder et al 2013;Pfisterer et al 2009).…”

Section: Study Characteristics Of Included Studiesmentioning

confidence: 99%

“…Seventeen out of 18 studies reported mortality at trial completion (Anguita et al 2010;Beck-da-Silva et al 2005;Berger et al 2010;Carubelli et al 2016;Eurlings et al 2010;Felker et al 2017;Januzzi et al 2011;Jourdain et al 2007;Karlstrom et al 2011;Lainchbury et al 2009;Maeder et al 2013;Ozkara et al 2007;Persson et al 2010;Pfisterer et al 2009;Schou et al 2013;Shah et al 2011;Stienen et al 2018;Troughton et al 2000). After extracting the end of trial mortality data, it was deemed inappropriate to conduct a meta-analysis, as the duration of the trial follow up periods differed between the trials.…”

Section: Reduction In Np Levels and Its Association With Mortalitymentioning

confidence: 99%

“…eight trials set individualized NP targets(Beck-da-Silva et al 2005;Eurlings et al 2010;Karlstrom et al 2011;Maeder et al 2013;Persson et al 2010;Pfisterer et al 2009;Schou et al 2013;Shah et al 2011;Stienen et al 2018), and one trial had no set NP target, but directed medical therapy to reduce the NP level(Ozkara et al 2007). The management of the standard care arms is shown in Additional file 1.Two trials were stopped early(Felker et al 2017;Januzzi et al 2011), Felker et.…”

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confidence: 99%

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Natriuretic peptide-directed medical therapy: a systematic review

et al. 2020

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Natriuretic peptides (NP) are strongly associated with perioperative cardiovascular events. However, in patients with raised NP, it remains unknown whether treatment to reduce NP levels prior to surgery results in better perioperative outcomes. In this systematic review and meta-analysis, we investigate NP-directed medical therapy in non-surgical patients to provide guidance for NP-directed medical therapy in surgical patients. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcome was to determine whether NP-directed medical therapy is effective in reducing NP levels within 6 months, compared to standard of care. The secondary outcome was to determine whether reducing NP levels is associated with decreased mortality. Full texts of 18 trials were reviewed. NP-directed medical therapy showed no significant difference compared to standard care in decreasing NP levels (standardized mean difference − 0.04 (− 0.16, 0.07)), but was associated with a 6-month (relative risk (RR) 0.82 (95% confidence interval (CI) 0.68-0.99)) reduction in mortality.

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“…The safety and tolerability of aliskiren in elderly patients has been evaluated in several trials [74][75][76][77][78]. These studies showed that aliskiren lowers BP effectively and is well tolerated, even in patients >75 years old.…”

Section: Antihypertensive Agentsmentioning

confidence: 99%

Management of Diabetic Nephropathy in the Elderly: Special Considerations

Alhamad²,

Reeves³

et al. 2012

J Nephrol Therapeut

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The incidence and prevalence of End-Stage Renal Disease (ESRD) secondary to Diabetic Nephropathy (DN) have been progressively increasing, reaching pandemic proportions over the past 20 years. Diabetes mellitus is responsible for more than 40% of all cases of ESRD in the United States. Despite that, the treatment of DN is still suboptimal. Both the elderly and diabetic populations are among the fastest growing categories. While several guidelines are available for management of DN in the general population, elderly patients have unique characteristics that may require adaptation of the general therapeutic guidelines used for the general population. Current therapy directed at delaying the progression of DN in elderly includes optimal glycemic and blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. This review highlights the available standard therapeutic approaches to manage progressive DN in elderly.

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Probrain Natriuretic Peptide for assessment of efficacy in heart failure treatment

Cited by 7 publications

References 18 publications

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Natriuretic peptide-directed medical therapy: a systematic review

Management of Diabetic Nephropathy in the Elderly: Special Considerations

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