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August 7, 2002

Nesiritide vs Nitroglycerin for Decompensated Congestive Heart Failure

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(5):571-573. doi:10.1001/jama.288.5.571

To the Editor: Dr Young and the Vasodilation in the Management of Acute [congestive heart failure] CHF (VMAC) investigators1 found that, among patients with decompensated CHF, nesiritide resulted in only a 2-mm improvement in pulmonary capillary wedge pressure (PCWP) compared with nitroglycerin and a 4-mm improvement compared with placebo at both 3 and 24 hours. Although they claimed nesiritide improves hemodynamic function, this small change is of no clinical significance. Subjective dyspnea, as well as all other parameters, were not different between the groups. At 7 days, there were 4 deaths in the nesiritide group and 1 death in the nitroglycerin group, as well as a 4% greater 6-month mortality with nesiritide. The similar baseline characteristics argue against the differences being due to sicker patients randomized to nesiritide. Another recent study of nesiritide2 also showed minimal improvement, but in the presence of significant and persistent hypotension.

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