Current Understanding Of The Compensatory Actions Of Cardiac Natriuretic Peptides in Cardiac Failure: A Clinical Perspective

Abstract

Natriuretic peptides play a crucial role in maintaining cardiovascular homeostasis. Among their properties are vasodilation, natriuresis, diuresis, and inhibition of cardiac remodeling. As heart failure progresses, however, natriuretic peptides fail to compensate. Knowledge of their processing and signaling pathways has guided the development of pharmacological therapies aimed at bolstering their effects. The drugs that have achieved the most clinical success have also stirred the most controversy. Nesiritide, the synthetic B-type natriuretic peptide, yielded significant symptomatic relief and improved haemodynamics but its use was plagued with questions surrounding its possibly harmful impact on renal function. More recently, compounds containing inhibitors of neprilysin, the enzyme responsible for degrading natriuretic peptides, have demonstrated morbidity and mortality benefit, but have also been linked to possible negative side effects. Clearly, potentiating the actions of natriuretic peptides for the benefit of patients is not as simple as just raising their serum concentration. This article reviews the current understanding of the compensatory actions of cardiac natriuretic peptides in heart failure and how this knowledge is revolutionizing heart failure therapy.

Combined Angiotensin Receptor–Neprilysin Inhibitors Improve Cardiac and Vascular Function Via Increased NO Bioavailability in Heart Failure

“…We believe the presence of increased BNP in the sacubitril/valsartan‐treated animals is suggestive of NEPi whereas reduced NT‐proBNP is likely attributable to decreased cardiomyocyte stress and, thus, reduced BNP transcription. The benefits of NPs are multidimensional and include reduced hemodynamic load, antifibrotic effects, antihypertrophic effects, vasodilatory effects, and others . Given the strong effect of NPs on these parameters, we next investigated the vascular function of the subject animals.…”

“…The benefits of NPs are multidimensional and include reduced hemodynamic load, antifibrotic effects, antihypertrophic effects, vasodilatory effects, and others. 44,45 Given the strong effect of NPs on these parameters, we next investigated the vascular function of the subject animals.…”

Atrial and Brain Natriuretic Peptides- Benefits and Limits of their use in Cardiovascular Diseases

“…They significantly increased the concentration of ANP and of other peptides like bradykinin, ANG II and endothelin I. They increased BP in hyperreninemic patients [ 39 ]. Omapatrilat, a common inhibitor of ACE and NEP, has beneficial hemodynamic effects but it significantly increases the risk of angioedema compared with enalapril(0.8% versus 0.5%) due to a stronger inhibition of bradykinin cleavage and it is therefore no longer used [ 39 ].…”

cBIN1 Score (CS) Identifies Ambulatory HFrEF Patients and Predicts Cardiovascular Events

“…Both BNP and its more stable and non-active version, N-terminal prohormone BNP (NT-proBNP) are secreted by cardiomyocytes in response to pressure and stretch. Active BNP results in a downstream natriuresis, diuresis, and vasodilatation ( Lee and Daniels, 2016 ). As stretch-response molecules, blood available BNP biomarkers help assess fluid status and assist in evaluating patients with acute dyspnea ( Januzzi et al, 2005 ).…”