Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide

David Mant, Richard Hobbs, Paul Glasziou, Lucy Wright, Rachel Hare, Rafael Perera, Christopher Price, Martin Cowie

Research output: Contribution to journalArticleResearchpeer-review

7 Citations (Scopus)

Abstract

Background

B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence.

Aim

To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients.

Design of study

Screening study with single-arm intervention.

Setting

A total of 1918 patients with diabetes mellitus or ischaemic heart disease aged >= 65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration.

Method

Eligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration of

Results

Seven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (P

Conclusion

About 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.

Original languageEnglish
Pages (from-to)393-399
Number of pages7
JournalBritish Journal of General Practice
Volume58
Issue number551
DOIs
Publication statusPublished - Jun 2008

Cite this

Mant, David ; Hobbs, Richard ; Glasziou, Paul ; Wright, Lucy ; Hare, Rachel ; Perera, Rafael ; Price, Christopher ; Cowie, Martin. / Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. In: British Journal of General Practice. 2008 ; Vol. 58, No. 551. pp. 393-399.
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abstract = "BackgroundB-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence.AimTo assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients.Design of studyScreening study with single-arm intervention.SettingA total of 1918 patients with diabetes mellitus or ischaemic heart disease aged >= 65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration.MethodEligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration ofResultsSeven-hundred and fifty-nine patients (40{\%}) attended for screening; 76 (10{\%} of 759) commenced treatment titration. Of these 76 patients, 64 (84{\%}) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36{\%}) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (PConclusionAbout 10{\%} of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.",
author = "David Mant and Richard Hobbs and Paul Glasziou and Lucy Wright and Rachel Hare and Rafael Perera and Christopher Price and Martin Cowie",
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language = "English",
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Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide. / Mant, David; Hobbs, Richard; Glasziou, Paul; Wright, Lucy; Hare, Rachel; Perera, Rafael; Price, Christopher; Cowie, Martin.

In: British Journal of General Practice, Vol. 58, No. 551, 06.2008, p. 393-399.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Identification and guided treatment of ventricular dysfunction in general practice using blood B-type natriuretic peptide

AU - Mant, David

AU - Hobbs, Richard

AU - Glasziou, Paul

AU - Wright, Lucy

AU - Hare, Rachel

AU - Perera, Rafael

AU - Price, Christopher

AU - Cowie, Martin

PY - 2008/6

Y1 - 2008/6

N2 - BackgroundB-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence.AimTo assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients.Design of studyScreening study with single-arm intervention.SettingA total of 1918 patients with diabetes mellitus or ischaemic heart disease aged >= 65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration.MethodEligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration ofResultsSeven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (PConclusionAbout 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.

AB - BackgroundB-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence.AimTo assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients.Design of studyScreening study with single-arm intervention.SettingA total of 1918 patients with diabetes mellitus or ischaemic heart disease aged >= 65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration.MethodEligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration ofResultsSeven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (PConclusionAbout 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.

U2 - 10.3399/bjgp08X299209

DO - 10.3399/bjgp08X299209

M3 - Article

VL - 58

SP - 393

EP - 399

JO - Journal of the Royal College of General Practitioners

JF - Journal of the Royal College of General Practitioners

SN - 0960-1643

IS - 551

ER -