Effect of diuretics on the plasma brain natriuretic peptide (BNP) level in patients with an acute exacerbation of COPD

Abstract

Background: Brain natriuretic peptide (BNP) is a cardiac biomarker originates from the stretched myocardium. Aim of the work: To evaluate the effect of mild diuretic treatment on the plasma BNP level in patients with an acute exacerbation of COPD without clinical findings of corpulmonale. Material and methods: 31 patients with acute exacerbation of COPD without any clinical evidence of corpulmonale who had elevated plasma BNP concentrations (group I) and 10 patients with stable COPD as controls (group II) participated in this study. A mild diuretic treatment in addition to the standard treatment for an acute attack of COPD was randomized to 16 patients in group 1 (group IA) and the remaining patients in group I only took standard treatment for acute COPD exacerbation (group IB). Plasma BNP concentrations were measured on admission and repeated on the 8th day post therapy. Results: Plasma BNP levels (mean ± SD in pg/ml) were significantly elevated in acute exacerbation of COPD than in stable patients (187.01 ± 62.7 vs 96.17 ± 26.97, p = 0.0001). There was a significant decrease in plasma BNP level in AECOPD patients post therapy, which was more striking in group IA than IB (179.09 ± 52.55 pre-treatment vs 77.43 ± 15.46 post-treatment with p = 0.0001 and 195.48 ± 72.93 pre-treatment vs 118.84 ± 45.19 post-treatment with p = 0.0001) respectively. There was a significant correlation between plasma BNP level and right ventricle end diastolic diameter (r = 0.5, p = 0.001) and pulmonary artery systolic pressure (r = 0.3, p = 0.04). Conclusion: Adding mild diuretics to the standard treatment for an acute attack of COPD may rapidly reduce plasma BNP levels in COPD patients with acute exacerbations who have high plasma BNP levels without any clinical evidence of corpulmonale.

Keywords

• Brain natriuretic peptide
• Chronic obstructive pulmonary disease
• Corpulmonale
• Diuretics