B-type natriuretic peptide (BNP) is shifted to the right during treatment with sacubitril/valsartan but remains a clinically valid biomarker with independent prognostic value similar with that of N-terminal pro-BNP (NT-proBNP), according to results of the PARADIGM-HF trial released March 4 in the Journal of the American College of Cardiology which will be presented during ACC.19 in New Orleans, LA.

PARADIGM-HF compared the long-term efficacy and safety of sacubitril/valsartan vs. enalapril in patients with heart failure with reduced ejection fraction. In this report, Peder Langeland Myhre, MD, PhD, et al., evaluated the relative prognostic value of BNP and NT-proBNP before and during treatment with sacubitril/valsartan.

BNP levels at 8 to 10 weeks of treatment were available for 24 percent (n=2,001) of all PARADIGM-HF patients. Median BNP increased from 202 ng/L to a peak median concentration of 235 ng/L after 8 to 10 weeks of sacubitril/valsartan and decreased to a median 181 ng/L after 8 to 10 weeks of enalapril treatment. During 8 to 10 weeks of treatment with sacubitril/valsartan, BNP increased by a median of 19 percent vs. a median decrease of 28 percent in NT-proBNP. In patients treated with enalapril, BNP decreased by a median of 6 percent compared with a 5 percent decrease in NT-proBNP. No significant difference was found between BNP and NT-proBNP in predicting outcomes at any timepoints during the study.

The authors conclude that, if available, NT-proBNP measurement is preferred to avoid clinical confusion during drug initiation with sacubitril/valsartan. However, if the NT-proBNP assay is not available, BNP measurement has comparable performance with respect to clinical prognosis. They also note that BNP should not be used to determine treatment adherence or response in individual patients.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: ACC19, ACC Annual Scientific Session, Natriuretic Peptide, Brain, Enalapril, Prognosis, Stroke Volume, Peptide Fragments, Aminobutyrates, Tetrazoles, Heart Failure, Biomarkers, Pharmacological

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