Effect of recombinant human brain natriuretic peptide (rhBNP) versus nitroglycerin in patients with heart failure A systematic review and meta-analysis

Abstract

Background: This study was the first to evaluate the therapeutic outcomes of recombinant human brain natriuretic peptide (rhBNP) versus nitroglycerin (NIT) in patients with heart failure (HF). Methods: The electronic databases were systematically searched to identify available studies. The pooled odds ratios (ORs) and their 95% confidence intervals (95% CIs) were analyzed to assess the mortality, readmission, hypotension, and renal dysfunction in the comparison of rhBNP and NIT therapies. Results: Final 5 randomized controlled trials (RCTs) involving 782 patients with HF were carried out in our study. The pooled OR of mortality, readmission, and hypotension showed that no significant difference was found in both drugs (P>0.05), with the absence of heterogeneity. The incidence of renal dysfunction was not significant difference in both groups (P=0.85). The pooledOR from 2 studies of Asian population using multivariate analysis demonstrated that the use of rhBNP was correlated with a significantly decreased risk of renal dysfunction (I2=0.0%, OR=0.19, P=0.001). Possible publication bias was not detected using Egger's test (P>0.05). Conclusions: The results suggested that rhBNP and NIT therapies were not significant difference in mortality, readmission, and hypotension. The use of rhBNP may become a useful predictor of renal dysfunction in Asian patients with HF. Additional studies are needed for Caucasian population with HF. Abbreviations: ADHF = acute decompensated heart failure, FDA = Food and Drug Administration, HF = heart failure, NIT = nitroglycerin, ORs = nitroglycerin, PCWP = pulmonary capillary wedge pressure, RAAS = renin-angiotensin-aldosterone system, RCTs = randomized controlled trials, rhBNP = recombinant human brain natriuretic peptide.