What question did this study set out to answer?

The study aims to evaluate the primary preventive effect of neurohumoral therapy in diabetic patients selected by NT-proBNP levels.

April 23, 2026Journal of the American College of Cardiology

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

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Type 2 diabetes with elevated NT-proBNP but free of cardiac disease (n=300). Intervention: Up-titration of renin-angiotensin system (RAS) antagonists and beta-blockers vs. Standard care at diabetes care units. Primary outcome: Hospitalization/death due to cardiac disease after 2 years (HR 0.351, 95% CI 0.127 to 0.975, p=0.044).

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Key result

Accelerated RAS and beta-blocker up-titration cuts cardiac hospitalization or death ~65% in diabetics with elevated NT-proBNP.

HR 0.351
95% CI 0.127 to 0.975
P=0.044
n=300

Why the study?

Few clinical trials have successfully demonstrated prevention of cardiac events in diabetes, potentially due to inaccurate patient selection, and NT-proBNP had not been assessed in this context.

Does intensified up-titration of RAS antagonists and beta-blockers reduce hospitalization or death due to cardiac disease in patients with type 2 diabetes, elevated NT-proBNP, and no history of cardiac disease?

Population

300 patients with type 2 diabetes and NT-proBNP >125 pg/ml free of cardiac disease

Comparison

Intensified RAS antagonist and beta-blocker up-titration vs usual care at diabetes care units

Design

Randomized controlled trial

Follow-up

2 years

Authors

MHM HuelsmannHeart Failure & Transplant SNStephanie NeuholdVienna General Hospital MRMichael ReslJohannes Kepler University of Linz

Discussion

Member takes

Implication

Supports NT-proBNP-guided RAS/beta-blocker up-titration in high-risk diabetics; provides first direct RCT evidence for primary prevention.

Key Points

The study aims to evaluate the primary preventive effect of neurohumoral therapy in diabetic patients selected by NT-proBNP levels.
300 patients with type 2 diabetes and elevated NT-proBNP were randomized into control and intensified treatment groups.
The intensified group received up-titration of renin-angiotensin system antagonists and beta-blockers at a cardiac clinic.
The primary endpoint was hospitalization or death due to cardiac disease after 2 years.
The intensified group showed a significant reduction in the primary endpoint (hazard ratio: 0.351; 95% CI: 0.127 to 0.975, p = 0.044).
Blood pressure significantly decreased in both groups (p < 0.05).
Heart rate reduction was observed only in the intensified group (p = 0.004).

Study Design

Type

RCT (n=300)

Multicenter

Yes

Structured PICO

Population

300 patients with type 2 diabetes, elevated NT-proBNP (>125 pg/ml) but free of cardiac disease. Mean age 67.5 ± 9 years, 37% male.

Intervention

Intensified treatment at a cardiac outpatient clinic for the up-titration of renin-angiotensin system (RAS) antagonists and beta-blockers.

Comparator

Standard care at 4 diabetes care units.

Outcome

Hospitalization or death due to cardiac disease after 2 years.composite

Main Result

Effect estimate: HR 0.351 (95% CI 0.127 to 0.975)

p-value: p=0.044

NT-proBNP-guided up-titration of RAS antagonists and beta-blockers significantly reduced cardiac events in high-risk diabetic patients without prior cardiac disease.

Cite This Study

Huelsmann et al. (2013) conducted an RCT in Type 2 diabetes with elevated NT-proBNP but free of cardiac disease (n=300). Up-titration of renin-angiotensin system (RAS) antagonists and beta-blockers vs. Standard care at diabetes care units was evaluated on Hospitalization/death due to cardiac disease after 2 years (HR 0.351, 95% CI 0.127 to 0.975, p=0.044). Accelerated up-titration of RAS antagonists and beta-blockers significantly reduced hospitalization or death due to cardiac disease in diabetic patients with elevated NT-proBNP (HR 0.351; 95% CI 0.127-0.975; p=0.044).

synapsesocial.com/papers/69e98f9f72ff25a8e3dbc07c https://doi.org/10.1016/j.jacc.2013.05.069

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Implication

Supports NT-proBNP-guided RAS/beta-blocker up-titration in high-risk diabetics; provides first direct RCT evidence for primary prevention.

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider