Table 2.

Trials comparing BNP guided therapy with clinically guided therapy.⁵

Study	Population	Intervention	Comparison	Implication
Beck-da-Silva, 20058	▪(LVEF) of 40% or less ▪Symptomatic HF (New York Heart Association class II–IV) for at least 3 months or previous hospital admission due to HF ▪Age (mean): 65 years. ▪< 50% males	-β-blocker dosage up-titrated according to plasma BNP levels plus standard care	-β-blocker dosage up-titrated according standard care	A trend toward better quality of life was seen in the BNP group as compared to the clinically guided group
Jourdain, 2007 STARS-BNP9	▪Symptomatic (New York Heart Association functional class II–III) systolic HF defined by left ventricular ejection fraction (LVEF) <45% ▪Age (mean): 65 years ▪<50% females	-Medical therapy was increasingly used with the aim of lowering plasma BNP levels (target <100 pg/ml) -Each class of therapy modified according to the judgment of the investigator	-Medical therapy was adjusted on the basis of the physical examination and usual para clinical and biological parameters	BNP guided strategy reduced the risk of CHF-related death or hospital stay for CHF
Pfisterer, 2009 TIME-CHF10	▪Dyspnea (New York Heart Association class ≥II with current therapy), a history of hospitalization for HF within the last year ▪Age (mean): 76 years ▪<50% females ▪Age subgroups: <75 years; ≥75 years)	-BNP guided plus symptom guided medical therapy -Medical therapy to reduce BNP levels to 2 times or less than the upper limit of normal (<400 pg/ml in patients <75 years and <800 pg/ml in patients ≥75 years) and symptoms to NYHA class of II or less	-Symptom guided medical therapy -Medical therapy to reduce symptoms to NYHA class of II or less	HF therapy guided by N-terminal BNP did not improve overall clinical outcomes or quality of life compared with symptom guided treatment HF therapy guided by N-terminal BNP improved outcomes in patients aged 60–75 years but not in those aged 75 years or older