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NT-proBNP is an inactive fragment of BNP secreted by stretched ventricle as response to wall stress in patients with heart failure. As a specific cardiac marker, elevated NT-proBNP correlates well with heart failure severity. The principle of heart failure therapy is modulation on neurohormonal activation. ARB can modulate neurohormon on RAA system, that result in decreasing NT-proBNP level and favorable outcomes. Reduction in NT-proBNP more than biologic variability (> 25%) shows a therapy response.This study was to analyze change of NT-proBNP after ARB therapy in ambulatory HF patients. This observational prospective study was carried from September to December 2015. Blood sampling was performed on patients who meet the inclusion criteria of the study at first visit and after 2 months therapy. NT-proBNP was measured by IMMULITE® as primary parameter and creatinin as secondary parameter. There are 14 patients met the inclusion criteria of the study (11 males and 3 females). ARB therapy used in patients were Valsartan (64%), Telmisartan (22%) and Candesartan (14%). After 2 months ARB therapy, a decrease in level of NT-proBNP with initial median 3092.5 (216 – 32112) pg/ml to 2135.5 (350 – 16172) pg/ml respectively were statistically significant (p=0.003). And the secondary parameter creatinin serum convert to eGFR shows a change in eGFR with initial median 73.33 (37.05 – 266.68) ml/minute to 81.04 (39.31 – 167.02) ml/minute respectively were statistically not significant (p=0.657). There were 7 patients (50%) have a decrease > 25%. In this study, we found that ARB therapy can change NT-proBNP level significantly after 2 months therapy.


Natriuretic Peptides NT-proBNP Heart Failure Angiotensin Receptor Blocker

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How to Cite
Dewi, I. K., Aminuddin, M., & Zulkarnain, B. S. (2017). ANALYSIS OF CHANGE IN NT-proBNP AFTER ANGIOTENSIN RECEPTOR BLOCKER (ARB) THERAPY IN PATIENT WITH HEART FAILURE. Folia Medica Indonesiana, 52(4), 305–309.


  1. Bui AL, Horwich TB, Fonarow GC (2011). Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8, 30-41
  2. Colledge NR, Walker BR, Ralston SH (2010). Davidson’s Principles and Practice of Medicine, 21st ed, Philadelphia, Elsevier, p 543-551
  3. Feola M, Menardi E, Ribichini F, Vado A, Deorsola A, Ferrero V, Visconti G, Milanese U, Uslenghi E (2003). Effects of the addition of a low dose of spironolactone on brain natriuretic peptide plasma level and cardiopulmonary function in patients with moderate congestive heart failure. Med Sci Monit 9, CR341-CR345
  4. Frankenstein L, Remppis A, Frankenstein J, Hess G, Zdunek D, Slottje K, Katus HA, Zugck C (2009). Variability of N-terminal probrain natriuretic peptide in stable chronic heart failure and its relation to changes in clinical variables. Clin Chem 55, 923-929
  5. Januzzi JL Jr (2012). The role of natriuretic peptide testing in guiding chronic heart failure management: review of available data and recommendations for use. Arch Cardiovasc Dis 105, 40-50
  6. Kasama S, Toyama T, Hatori T, Sumino H, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, Kurabayashi M (2006). Comparative effects of valsartan and enalapril on cardiac sympathetic nerve activity and plasma brain natriuretic peptide in patients with congestive heart failure. Heart 92, 625-630
  7. Latini R, Masson S, Anand I, Judd D, Maggioni AP, Chiang YT, Bevilacqua M, Salio M, Cardano P, Dunselman PH, Holwerda NJ, Tognoni G, Cohn JN; Valsartan Heart Failure Trial Investigators (2002). Effects of valsartan on circulating brain natriuretic peptide and norepinephrine in symptomatic chronic heart failure: the Valsartan Heart Failure Trial (Val-HeFT). Circulation 106, 2454-2458
  8. Lee YS, Kim KS, Lee JB, Ryu JK, Choi JY, Kim BK, Chang SG, Hur SH, Lee BR, Jung BC, Hong GR, Kim BS, Park TH, Kim YD, Kim TI, Kim DS (2011). Effect of valsartan on N-terminal pro-brain natriuretic Peptide in patient with stable chronic heart failure: comparison with enalapril. Korean Circ J 41, 61-67
  9. Maggioni AP, Anand I, Gottlieb SO, Latini R, Tognoni G, Cohn JN; Val-HeFT Investigators (Valsartan Heart Failure Trial) (2002). Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors. J Am Coll Cardiol 40, 1414-1421
  10. Mann DL (2012). Pathophysiology of Heart Failure. In: Bonow RO, Mann DL, Zipes DP, Libby P (eds). Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed, Philadelphia, Saunders
  11. Masson S, Latini R, Anand IS, Barlera S, Angelici L, Vago T, Tognoni G, Cohn JN; Val-HeFT Investigators (2008). Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial). J Am Coll Cardiol 52, 997-1003
  12. Miyata M, Sasaki T, Ikeda Y, Shinsato T, Kubozono T, Furusho Y, Kusumoto A, Hamasaki S, Tei C; COLD-CHF Investigators (2012). Comparative study of therapeutic effects of short- and long-acting loop diuretics in outpatients with chronic heart failure (COLD-CHF). J Cardiol 59, 352-358
  13. Page RL & Nappi JM (2013). Acute coronary syndrome. In: Alldredge BK, Corelli RL, Ernst ME, Guglielmo Jr BJ, Jacobson PA, Kradjan WA, Williams BR (eds). Koda-Kimble and Young's Applied Therapeutics: The Clinical Use of Drugs, 10th ed, Philadelphia, Lippincott Williams & Wilkins, p 436-488
  14. Srisawasdi P, Vanavanan S, Charoenpanichkit C, Kroll MH (2010). The effect of renal dysfunction on BNP, NT-proBNP, and their ratio. Am J Clin Pathol 133, 14-23
  15. Troughton R, Michael Felker G, Januzzi JL Jr (2014). Natriuretic peptide-guided heart failure management. Eur Heart J 35, 16-24
  16. Tsutamoto T, Wada A, Maeda K, Mabuchi N, Hayashi M, Tsutsui T, Ohnishi M, Sawaki M, Fujii M, Matsumoto T, Matsui T, Kinoshita M (2001). Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure. J Am Coll Cardiol 37, 1228-1233
  17. van Kimmenade RR and Januzzi JL Jr (2012). Emerging biomarkers in heart failure. Clin Chem 58, 127-138
  18. Weber M and Hamm C (2006). Role of B-Type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart 92, 843-849