Application of loop diuretics in patients with heart failure according to plasma brain natriuretic peptide level

Objectives To investigate the use of loop diuretics guided by plasma brain natriuretic peptide(BNP) level in reducing side effects in patients with heart failure.Methods Totally 100 patients with heart failure were randomly divided into 2 groups.The use of loop diuretics was based on the NYHA classification plus weight(N +W group) and plasma BNP level plus weight(B +W group) respectively.Plasma B-type BNP,serum creatinine(CR),blood fat,blood uric acid,blood electrolyte and blood pressure were regularly measured and analyzed dynamically.Results(1)At baseline,plasma concentrations of BNP,creatinine,total cholesterol and blood potassium,blood sodium,serum chloride,blood uric acid level,blood pressure were not significantly different between the two groups(P=0.122,0.08,0.07,0.577,0.645,0.81,0.091,and 0.21,respectively).Blood triglyceride level in N +W group was higher than that in B +W group(P =0.01).(2)During the retain of minimal effective dose of diuretics,plasma BNP level,creatinine,blood total cholesterol,blood triglyceride and blood pressure were significantly different between the two groups(P=0.042,0.036,0.02,0.03,and 0.03,respectively);meanwhile,blood potassium,blood sodium,serum chloride and blood uric acid level were not significantly different(P =1,0.088,0.387 and 0.067,respectively).(3)After 1 month's therapy,plasma BNP level,creatinine,blood triglyceride,blood uric acid,blood pressure and blood potassium,blood sodium,serum chloride were significantly different between the two groups(P0.001,P=0.02,0.01,0.01,0.007,0.017,0.001 and 0.001,respectively);whereas blood total cholesterol was not significantly different(P=0.06).(4)From baseline to treatment of minimal effective dose,8 patients(16%) showed recurrence of heart failure in N+W group and 10 cases(20%) in B+W group(P=0.795).After 1 month's maintenance therapy,9 patients(18%) showed recurrence of heart failure in N +W group and only 1 case(2%)in B +W group(P =0.016).Conclusions Use of loop diuretics guided by plasma BNP level can reduce the recurrence of heart failure and side effects of diuretics in patients with heart failure.