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Isosorbide-5-Mononitrate Therapy Lowers Atrial Natriuretic Peptide Levels

Oral, long-term isosorbide-5-mononitrate therapy lowers atrial natriuretic peptide levels among patients with left ventricular (LV) dysfunction after acute myocardial infarction, research indicates.

There was also a reduced need for additional diuretics among treated patients. Less LV dilatation was observed in patients with more severe LV dysfunction at baseline, found clinicians at the Department of Cardiology, University Hospital, Lund, Sweden.

They point out that nitrates are often combined with other pharmacologic agents in the management of chronic heart failure (CHF). At the same time, information is limited about the long-term effects among patients already receiving standard heart failure therapy, and with evidence of LV dysfunction after acute myocardial infarction (AMI).

In a randomized, double-blind, placebo-controlled trial of 92 patients, the clinicians evaluated the effects of isosorbide-5-mononitrate (IS-5-MN) at 60 mg daily for 11 months (47 patients) and placebo (45 patients). They subjects had clinical or echocardiographic evidence of left ventricular dysfunction after acute myocardial infarction.

The trial found that invasive hemodynamic measurements did not show any difference between the treatment regimens. Overall changes in echocardiographic measurements were not significantly different between patients receiving IS-5-MN therapy and those who received placebo.

However, differences were found among members of a specific subgroup of patients who had left ventricular ejection fraction less than, or equal to, 40% at baseline. Among this group, IS-5-MN therapy resulted in a lesser increase of end-diastolic volume index than the placebo. In addition, IS-5-MN significantly reduced the serum concentration of atrial natriuretic peptide (mean 20.0 pmol/), while there was no change among patients in the placebo group.

The clinicians also found among the IS-5-MN group, a significant reduction among the proportion of patients taking diuretics: from 30 of 44 to 20 of 44. There was no such effect among patients in the placebo group, which remained at 27 of 43 using diuretics.
Am Heart J 2003 Jan;145(1):E1. "Randomized, double-blind, placebo-controlled long-term study of isosorbide-5-mononitrate therapy in patients with left ventricular dysfunction after acute myocardial infarction."

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