n congestive heart failure, neurohormonal factors such as the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system are activated, and the RAAS activation may lead to deterioration of heart failure (HF) due to the vasoconstrictive and volume-retaining effects. 1 Atrial natriuretic peptide (ANP) demonstrates increased secretion in proportion to the severity of HF, and may act to counterbalance the adverse effects of the RAAS through its direct vasodilatory action, inhibition of the excessive release of renin and aldosterone, and by its direct diuretic and natriuretic effects. [2][3][4] As reported in the Study of Left Ventricular Dysfunction (SOLVD), early-stage HF is characterized by an increase in circulating ANP without activation of the RAAS or body fluid retention. 5 Considering these hormonal profiles and the body fluid balance, ANP may be one of the principal factors inhibiting the activation of the RAAS and body fluid retention in early-stage HF. However, in advanced HF the intracardiac pressure increases, volume overload develops, and the RAAS activates in spite of the fact that the plasma ANP level remains elevated above basal values. Elevated plasma ANP in advanced HF may not be as effective as expected. In addition, the responsiveness to exogenous ANP decreases in renin suppression or renal excretion in advanced HF. 6 Thus the decreased responsiveness to endogenous ANP may play a part in the pathogenesis of vasoconstriction, activation of the RAAS and body fluid retention in HF. However, it has not been demonstrated experimentally whether hyporesponsiveness to ANP is directly related to the progression of HF.We and others have attempted to clarify the role of endogenous ANP in HF through short-term inhibition of ANP activity using an ANP receptor antagonist, HS-142-1. 4,[7][8][9][10][11] However, the influence of long-term inhibition of endogenous ANP activity by an ANP receptor antagonist in established HF, in which ANP has previously exerted an effect, has not been determined. We assumed that longterm inhibition of endogenous ANP activity in early-stage HF provokes the progression to advanced HF. It is important to examine how long-term inhibition of endogenous ANP affects cardiorenal and neurohormonal factors in early-stage HF in order to clarify the exact role of ANP in the progression from early-stage to advanced HF.The objective of the present study is to clarify whether endogenous ANP inhibits the deterioration of early-stage HF by investigating the effects of long-term suppression of endogenous ANP activity by HS-142-1 in dogs with earlystage HF. Furthermore, since it is expected that the longterm inhibition of endogenous ANP will cause the activation of various substances that affect vascular tone, hormonal secretion and renal functions, we compared the differences in the effects of short-term and long-term inhibition, and determined the direct and indirect influences of the suppression of endogenous ANP in early-stage HF.
Short-Term and Long-Term Inhibition of Endoge...