[Treatment of patients with chronic heart failure based on monitoring of concentrations of natriuretic peptides--to what extent it is justified in clinical practice?].

: The review is devoted to consideration of novel pathways of treatment of patients with chronic heart failure (CHF) in particular of the high risk group. All main studies of the problem of treatment of patients with CHF based on monitoring of concentration of natriuretic peptides (MCNUP) BNP or NT-proBNP have been analyzed. The use of MCNUP with the aim of optimizing treatment of patients with CHF is completely justified biologically. Nevertheless results of available studies gave no 100% evidence of efficacy of such therapy mostly because of insufficient statistical power of these studies to obtain such a proof. In most of positive studies effect of MCNUP controlled therapy was assessed with the use of composite end points and main contribution in achievement of success was made not by effect on mortality but on stabilization of clinical state with lowering of number of hospitalizations due to CHF. This fact was confirmed in most of the protocols--both positive and neutral--in patients younger than 75 years with systolic left ventricular dysfunction. Taking into consideration pronounced effect of MCNUP controlled therapy on development of repeat decompensations and CHF related hospitalizations this variant of therapy can be justified especially in high risk patients requiring intensified control and optimization of therapy after discharge from hospital.