Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb 18:9:5.
doi: 10.1186/s13741-019-0134-y. eCollection 2020.

Natriuretic peptide-directed medical therapy: a systematic review

Christella S Alphonsus  1 , Pooveshnie Govender  2 , Reitze N Rodseth  3 , Bruce M Biccard  1
Affiliations
Review

Natriuretic peptide-directed medical therapy: a systematic review

Christella S Alphonsus et al. Perioper Med (Lond). .

Abstract

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.

Keywords: Cardiac morbidity; Myocardial ischemia; Pre-operative evaluation.

PubMed Disclaimer

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2.
Fig. 2.
Efficacy of natriuretic peptide-directed medical therapy versus control in reducing BNP-levels within 6 months (Standardised mean difference in natriuretic peptide levels in NP-directed medical therapy clinical trials). SD, standard deviation; CI, confidence interval
Fig. 3
Fig. 3
Effect of natriuretic peptide guided medical therapy versus control on mortality after 6 months. CI-confidence interval
See this image and copyright information in PMC

References

    1. Alphonsus CS, Govender P, Rodseth RN, Biccard BM. The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review. Perioperative Medicine. 2019;8:14. doi: 10.1186/s13741-019-0124-0. - DOI - PMC - PubMed
    1. Anguita M, Esteban F, Castillo JC, Mazuelos F, Lopez-Granados A, Arizon JM, Suarez De Lezo J. Usefulness of brain natriuretic peptide levels, as compared with usual clinical control, for the treatment monitoring of patients with heart failure. Med Clin (Barc) 2010;135(10):435–440. doi: 10.1016/j.medcli.2009.11.048. - DOI - PubMed
    1. Beck-da-Silva L, de Bold A, Fraser M, Williams K, Haddad H. BNP-guided therapy not better than expert's clinical assessment for beta-blocker titration in patients with heart failure. Congest Heart Fail. 2005;11(5):248–253. doi: 10.1111/j.1527-5299.2005.04239.x. - DOI - PubMed
    1. Berger R, Moertl D, Peter S, Ahmadi R, Huelsmann M, Yamuti S, Wagner B, Pacher R. N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3-arm, prospective, randomized pilot study. J Am Coll Cardiol. 2010;55(7):645–653. doi: 10.1016/j.jacc.2009.08.078. - DOI - PubMed
    1. Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, Guyatt G, Cruz P, Graham M, Wang CY, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120(3):564–578. doi: 10.1097/ALN.0000000000000113. - DOI - PubMed

LinkOut - more resources