فهرست نشریات علمی دسترسی آزاد ایران

Background and Objectives: Hypotension in elderly patients with acute decompensated heart failure (ADHF) limits vasodilator use. Recombinant human brain natriuretic peptide (rhBNP) may improve cardiac function, and combining it with low-dose norepinephrine could maintain perfusion. This study evaluated the efficacy and safety of this approach.    Methods: In this single-center, open-label randomized exploratory trial, 70 elderly patients were assigned to norepinephrine alone or rhBNP plus norepinephrine. Hemodynamics, biomarkers, echocardiography, and short-term outcomes were assessed over 3–7 days, with 30-day follow-up.    Results: The study group showed significant increases in SBP (mean +7 mmHg), DBP (+6 mmHg), MAP (+9 mmHg), SpO₂ (+2%), and LVEF (+5%), and reductions in HR (–6 bpm), RR (–7 bpm), and NT-proBNP (–2000 ng/L; all P<0.05, as assessed by t-test or Wilcoxon rank-sum test). Total bilirubin levels showed a significant reduction (–3 μmol/L; P<0.05). While serum sodium changes were statistically significant, the clinical relevance of the absolute difference was negligible. The study group had increased 24-hour fluid intake and urine output, shorter hospital stays, and higher ARNI prescription rates and dosages at discharge (P<0.05). Overall treatment efficacy at discharge was higher in the study group (94.29% vs. 88.57%, P=0.006), with a significantly lower 30-day readmission rate (14.71% vs. 36.36%, P=0.042). No significant differences were observed in adverse drug reactions or 30-day mortality. Statistical analyses were performed using t-tests, ANOVA, Wilcoxon rank-sum, and chi-square tests, with P<0.05 considered significant.    Conclusion: rhBNP combined with low-dose norepinephrine improved short-term hemodynamics without increasing risk; larger trials are warranted.