Cited by 385Heart Failure Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsChronic Kidney Disease and Diabetes

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PONTIAC (NT-proBNP Selected PreventiOn of cardiac eveNts in a populaTion of dIabetic patients without A history of Cardiac disease)

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Huelsmann, Martin, Neuhold, Stephanie, Resl, Michael, Strunk, Guido, Brath, Helmut, Francesconi, Claudia, Adlbrecht, Christopher, Prager, Rudolf, Luger, Anton, Pacher, Richard, Clodi, Martin·2013·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2013.05.069

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Abstract

Objectives The study sought to assess the primary preventive effect of neurohumoral therapy in high-risk diabetic patients selected by N-terminal pro-B-type natriuretic peptide (NT-proBNP). Background Few clinical trials have successfully demonstrated the prevention of cardiac events in patients with diabetes. One reason for this might be an inaccurate selection of patients. NT-proBNP has not been assessed in this context. Methods A total of 300 patients with type 2 diabetes, elevated NT-proBNP (>125 pg/ml) but free of cardiac disease were randomized. The "control" group was cared for at 4 diabetes care units; the "intensified" group was additionally treated at a cardiac outpatient clinic for the up-titration of renin-angiotensin system (RAS) antagonists and beta-blockers. The primary endpoint was hospitalization/death due to cardiac disease after 2 years. Results At baseline, the mean age of the patients was 67.5 ± 9 years, duration of diabetes was 15 ± 12 years, 37% were male, HbA1c was 7 ± 1.1%, blood pressure was 151 ± 22 mm Hg, heart rate was 72 ± 11 beats/min, median NT-proBNP was 265.5 pg/ml (interquartile range: 180.8 to 401.8 pg/ml). After 12 months there was a significant difference between the number of patients treated with a RAS antagonist/beta-blocker and the dosage reached between groups (p < 0.0001). Blood pressure was significantly reduced in both (p < 0.05); heart rate was only reduced in the intensified group (p = 0.004). A significant reduction of the primary endpoint (hazard ratio: 0.351; 95% confidence interval: 0.127 to 0.975, p = 0.044) was visible in the intensified group. The same was true for other endpoints: all-cause hospitalization, unplanned cardiovascular hospitalizations/death (p < 0.05 for all). Conclusions Accelerated up-titration of RAS antagonists and beta-blockers to maximum tolerated dosages is an effective and safe intervention for the primary prevention of cardiac events for diabetic patients pre-selected using NT-proBNP. (Nt-proBNP Guided Primary Prevention of CV Events in Diabetic Patients [PONTIAC]; NCT00562952).

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Authors: Huelsmann, M., Neuhold, S., Resl, M., Strunk, G., Brath, H., Francesconi, C., Adlbrecht, C., Prager, R., Luger, A., Pacher, R., & Clodi, M.
Affiliations: Medical University of Vienna (AT)
TU Dortmund University (DE)
Klinik Hietzing (AT)
Corresponding author: Pacher, Richard
ORCID: Resl, Michael
Strunk, Guido
Brath, Helmut
Adlbrecht, Christopher
Clodi, Martin
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2013-10
Volume: 62
Issue: 15
Pages: 1365-1372
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2013.05.069
OpenAlex: W2113538868
Cited by: 385
References: 29
Citations by year: 2026: 43 · 2025: 41 · 2024: 43 · 2023: 34 · 2022: 39 · 2021: 30 · 2020: 28 · 2019: 22 · 2018: 24 · 2017: 26 · 2016: 26 · 2015: 14 · 2014: 11 · 2013: 3
FWCI: 12.25
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 372 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: Universität Wien
Medizinische Universität Wien
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords: NT-proBNP, type 2 diabetes, renin-angiotensin system inhibitors, beta-blockers, cardiovascular hospitalization, cardiovascular mortality, heart rate reduction, blood pressure reduction, cardiovascular risk stratification, all-cause hospitalization
MeSH terms: Aged, Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, Diabetes Mellitus, Type 2, Female, Heart Diseases, Heart Rate, Hospitalization, Humans, Male, Peptide Fragments, Primary Prevention, Prospective Studies, Biomarkers, Natriuretic Peptide, Brain, Kaplan-Meier Estimate, Angiotensin Receptor Antagonists

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PONTIAC (NT-proBNP Selected PreventiOn of cardiac eveNts in a populaTion of dIabetic patients without A history of Cardiac disease)

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