Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a beta-blocker: results from the Carvedilol Or Metoprolol European Trial (COMET) trial

Eur J Heart Fail. 2007 Aug;9(8):795-801. doi: 10.1016/j.ejheart.2007.07.010.


Background: Plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP) are increased in patients with chronic heart failure (CHF). Beta-blockers (BB) may influence these levels but it is unclear whether changes in NT-pro BNP reflect concomitant changes in prognosis.

Objectives: To assess the prognostic importance of NT-pro BNP at baseline and during follow-up, in patients in whom beta-blocker therapy is initiated.

Methods: In COMET, 3029 patients with CHF in NYHA class II-IV and EF<35% were randomised to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Blood samples were collected for the measurement of NT-pro BNP at baseline (n=1559) and during follow-up (n=309).

Results: Baseline plasma concentrations of NT-pro BNP above the median (1242 pg/ml) were associated with higher all-cause mortality (RR 2.77; 95% CI 2.33-3.3, p<0.001). Patients who achieved NT-pro BNP levels<400 pg/ml during follow-up had a lower subsequent mortality (RR 0.32; 95% CI 0.15-0.69, p=0.004).

Conclusions: The plasma concentration of NT-pro BNP is a powerful predictor of mortality in patients with CHF. Patients who achieve an NT-pro BNP of <400 pg/ml subsequent to treatment with a beta-blocker have a favourable prognosis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Carbazoles / therapeutic use*
  • Carvedilol
  • Chronic Disease
  • Female
  • Heart Failure / blood*
  • Heart Failure / drug therapy
  • Heart Failure / mortality*
  • Humans
  • Male
  • Metoprolol / therapeutic use*
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Propanolamines / therapeutic use*


  • Adrenergic beta-Antagonists
  • Carbazoles
  • Peptide Fragments
  • Propanolamines
  • pro-brain natriuretic peptide (1-76)
  • Carvedilol
  • Natriuretic Peptide, Brain
  • Metoprolol