BNP‐Guided Therapy Not Better Than Expert's Clinical Assessment for β‐Blocker Titration in Patients With Heart Failure

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Abstract
B‐type natriuretic peptide (BNP) is a cardiac neurohormone used as a noninvasive tool for diagnosing and monitoring heart failure. Beta blockers have beneficial effects in patients with heart failure as well as a direct effect on BNP plasma levels. The aim of this study is to compare the efficacy of a BNP‐guided approach vs. standard care on β‐blocker titration in heart failure patients. Forty‐one patients with heart failure were randomized into a clinical trial. Bisoprolol was started, and the dose was regularly up‐titrated. BNP was measured monthly. The clinical group had β‐blocker dosage increased according to standard care, whereas the BNP group had β‐blocker dosage up‐titrated according to plasma BNP levels plus standard care. The primary outcome was mean β‐blocker dose achieved after 3 months. BNP levels, left ventricular ejection fraction, clinical score, quality of life, and hospitalization were collected in all patients. BNP‐guided up‐titration of β blocker in ambulatory patients with heart failure did not result in higher doses of β blocker at the end of 3 months ± SD (5.9±4.3 mg vs. 4.4±3.4 mg, p=0.22). Left ventricular ejection fraction was significantly improved in both groups by 7.3% (95% confidence interval, 4.1%–10.4%; p