Pathophysiological significance and clinical application of ANP and BNP in patients with heart failure

2001 ◽  
Vol 79 (8) ◽  
pp. 730-735 ◽  
Author(s):  
Michihiro Yoshimura ◽  
Hirofumi Yasue ◽  
Hisao Ogawa

Plasma levels of ANP and BNP increase in accordance with the severity of the heart failure. In severe cases, the amount of BNP secreted surpasses that of ANP. The main secretion site of BNP is the ventricles, and that of ANP is the atria. However, ANP is also secreted from the ventricles as heart failure advances, and thus the ventricles are important sites for both BNP and ANP. It is well known that myocardial stretch is a key factor in the stimulation of the secretion of ANP and BNP, although neurohumoral factors also play a role in the secretion mechanism. The major physiological effects of ANP and BNP are vasodilation, natriuresis, and inhibition of the renin-angiotensin-aldosterone (RAA) and the sympathetic nervous systems; all of which are supposed to suppress the progression of heart failure. The inhibitory action of ANP and BNP on the RAA system has been considered to be an extra-cardiac effect. We recently reported the activation of an angiotensin-converting enzyme and aldosterone production in failing human hearts. ANP and BNP, however, would inhibit aldosterone production, not only in the adrenal cortex but also in cardiac tissue. ANP, and especially BNP, are useful markers of the heart's status during treatment for heart failure. The infusion of synthetic ANP (hANP) or BNP (Nesiritide®) is effective in the treatment of acute heart failure. In Japan, BNP occupies an important position in the diagnosis of chronic heart failure, as ANP does in the treatment of acute heart failure.Key words: natriuretic peptide, heart failure, myocardial infarction, cardiomyopathy, aldosterone.

2007 ◽  
Vol 292 (2) ◽  
pp. R946-R954 ◽  
Author(s):  
Tomohito Ohtani ◽  
Miho Ohta ◽  
Kazuhiro Yamamoto ◽  
Toshiaki Mano ◽  
Yasushi Sakata ◽  
...  

Cardiac aldosterone levels have not been evaluated in diastolic heart failure (DHF), and its roles in this type of heart failure remain unclear. This study aimed to detect cardiac aldosterone by use of a liquid chromatographic-mass spectrometric method and to assess the effects of mineralocorticoid receptor blockade on hypertensive DHF. Dahl salt-sensitive rats fed 8% NaCl diet from 7 wk (hypertensive DHF model) were divided at 13 wk into three groups: those treated with subdepressor doses of eplerenone (12.5 or 40 mg·kg−1·day−1) and an untreated group. Dahl salt-sensitive rats fed 0.3% NaCl diet served as controls. Cardiac aldosterone was detected in the DHF rats but not in the control rats, with increased ventricular levels of mineralocorticoid receptor. Cardiac levels of 11-deoxycorticosterone, corticosterone, and 11-dehydrocorticosterone were not different between the control and DHF rats, but the tissue level of corticosterone that has an affinity to mineralocorticoid receptor was 1,000 times as high as that of aldosterone. Aldosterone synthase activity and CYP11B2 mRNA were undetectable in the ventricular tissue of the DHF rats. Administration of eplerenone attenuated ventricular hypertrophy, ventricular fibrosis, myocardial stiffening, and relaxation abnormality, leading to the prevention of overt DHF. In summary, the myocardial aldosterone level increased in the DHF rats. However, its value was extremely low compared with corticosterone, and no evidence for enhancement of intrinsic myocardial aldosterone production was found. The upregulation of mineralocorticoid receptor may play a central role in the pathogenesis of DHF, and blockade of mineralocorticoid receptor is likely an effective therapeutic regimen of DHF.


2012 ◽  
Vol 18 (8) ◽  
pp. S9
Author(s):  
Bryan J. Taylor ◽  
Maile L. Ceridon ◽  
Eric M. Snyder ◽  
Bruce D. Johnson

2021 ◽  
Vol 2 (1) ◽  
pp. 8-16
Author(s):  
Y. V. Alyokhina ◽  
E. M. Seredenina ◽  
A. L. Kalinkin

The risk factors, clinical manifestations, pathophysiology, diagnosis and treatment options for central sleep apnea and Cheyne-Stokes respiration in patients with heart failure are highlighted in this review. The effectiveness and prospects of therapeutic approaches are discussed: CPAP therapy, adaptive servo ventilation, transvenous stimulation of the phrenic nerve.


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