Effect of beta-adrenergic receptor blockade on atrial natriuretic peptide in essential hypertension.

Nakaoka, Hidenori; Kitahara, Younosuke; Amano, Masao; Imataka, Kouji; Fujii, Jun; Ishibashi, Masayoshi; Yamaji, Taiki

doi:10.1161/01.hyp.10.2.221

Cited by 75 publications

(37 citation statements)

References 27 publications

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“…Carvedilol, in common with other ␤-blockers, enhances plasma concentrations of ANP. 18 This may reflect drug-induced downregulation of natriuretic peptide clearance receptors. 19 It is possible that some of the benefit of carvedilol is derived from enhancing plasma ANP (and/or BNP) with promotion of natriuresis, vasodilation, and relative suppression of sympathetic and renin-angiotensin-aldosterone systems.…”

Section: Discussionmentioning

confidence: 99%

Neurohumoral Prediction of Benefit From Carvedilol in Ischemic Left Ventricular Dysfunction

Richards¹,

Doughty²,

Nicholls³

et al. 1999

Circulation

196

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Background-Plasma neurohormones were analyzed for prediction of adverse outcomes and response to treatment in 415 patients with ischemic left ventricular dysfunction randomly assigned to receive carvedilol or placebo. Methods and Results-Atrial natriuretic peptide, brain natriuretic peptide (BNP), or norepinephrine (NE) levels above the group median were associated with increased mortality rates and heart failure. On multivariate analysis, both BNP and NE interacted with treatment to predict death or heart failure independent of age, New York Heart Association class, and left ventricular ejection fraction. For placebo, supramedian levels of BNP were associated with 3-fold the mortality rate of inframedian levels (20/104; 19% vs 6/99; 6%; PϽ0.01). For carvedilol, mortality rate was comparable in these 2 subgroups (12/109; 11% vs 8/94; 9%; NS). Corresponding rates for heart failure were 29/104 (28%) versus 3/99 (3%; PϽ0.001) for placebo and 16/109 (15%) versus 7/94 (7%; NS) for carvedilol. High NE levels did not predict additional benefit from carvedilol, which significantly reduced heart failure admissions only in those with NE levels below the median (13.1% to 4.0%; PϽ0.01). In the 23% of the study population with supramedian BNP but inframedian levels of NE, carvedilol reduced hospital admission with heart failure by Ͼ90% (PϽ0.001). Conclusions-Carvedilol reduced mortality rates and heart failure in those with higher pretreatment BNP levels but lesser activation of plasma NE. Neurohumoral profiling may guide introduction of ␤-blockade in heart failure. (Circulation. 1999;99:786-792.)

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Section: Discussionmentioning

confidence: 99%

Neurohumoral Prediction of Benefit From Carvedilol in Ischemic Left Ventricular Dysfunction

Richards¹,

Doughty²,

Nicholls³

et al. 1999

Circulation

196

View full text Add to dashboard Cite

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“…The effect of BB on plasma NP has been reported in population-based studies, 15 in healthy control subjects, 16 during exercise, in hypertension, 17,18 in coronary disease, 19 and in HF. 20 -30 The reported responses are widely divergent, presumably reflecting differences between specific ␤-blockers and the effects of dose and duration of treatment and clinical state.…”

Section: Clinical Perspective P 985mentioning

confidence: 96%

Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure

et al. 2006

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Background-The effect of ␤-blockade on the cardiac natriuretic peptides is poorly understood but could contribute to their beneficial treatment effect and may be relevant to clinical use of plasma brain natriuretic peptide (BNP)/N-terminal pro brain natriuretic peptide (NTproBNP) measurements in risk stratification and in titration of anti-heart failure therapy. Methods and Results-Sixteen men with mild, stable heart failure (NYHA class II to III; left ventricular ejection fraction Ͻ40%) underwent serial blood sampling for plasma natriuretic peptide levels and received infusions of atrial natriuretic peptide (ANP) and BNP before and 6 weeks after the introduction and uptitration of metoprolol or 6 weeks unchanged therapy in a randomized, parallel-group design. Plasma natriuretic peptides (BNP, NTproBNP, ANP, and NTproANP) were increased by metoprolol (PϽ0.01 for all). The natriuretic responses to ANP and BNP infusions were sustained with the introduction of metoprolol despite reduced renal perfusion pressure. The levels of the noninfused natriuretic peptide were increased by both ANP and BNP infusions, and this effect was enhanced by metoprolol. The early plasma half-life (t 1 ⁄2␣) of BNP was prolonged by metoprolol (5.6Ϯ0.45 to 11Ϯ1.3 versus 5.7Ϯ0.8 to 6.6Ϯ1.3 minutes in control subjects; Pϭ0.019). Conclusions-Plasma cardiac natriuretic peptide levels increase significantly with the introduction of metoprolol in heart failure as a result of effects on secretion and clearance. Natriuretic responses to NP infusions are sustained with ␤-blockade despite reduced renal perfusion pressure. Clinicians should be aware that the introduction of metoprolol causes a rise in plasma BNP/NTproBNP that is unrelated to deterioration in clinical status and must be considered when measurements are undertaken for risk stratification or titration of treatment.

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“…5,6 This is corroborated by other studies that demonstrated augmentation of cardiac natriuretic peptides by pharmacological -receptor blockade in humans. [7][8][9] However, the precise effect of the sympathetic nervous system on the natriuretic peptide system remains unclear.Therefore, we examined the effect of ETS of the second …”

mentioning

confidence: 99%

Effect of Endoscopic Transthoracic Sympathicotomy on Plasma Natriuretic Peptide Concentrations in Humans

Nakamura

Yoshizawa

Hirasawa

et al. 2005

Circ J

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ndoscopic transthoracic sympathicotomy (ETS) is a safe and effective procedure that is used for the treatment of palmar hyperhidrosis. 1,2 The upper third or fourth thoracic, stellate, and cervical sympathetic ganglia receive the preganglionic fibers from the upper 4 thoracic segments of the spinal cord and direct the postganglionic fibers to the heart, upper extremities and cranial vessels. 3 Therefore, ETS results in blockade of efferent sympathetic nerves that innervate the heart and upper extremities.Natriuretic peptides are secreted into the systemic circulation in response to numerous factors, including increased atrial and/or ventricular wall tension, tachycardia, exercise, endothelin, arginine vasopressin and catecholamines. 4 An interaction between the sympathetic nervous system and the natriuretic peptide system has been suggested by experimental studies that demonstrated suppression of cardiac atrial natriuretic peptide (ANP) release in response to -adrenergic stimulation. 5,6 This is corroborated by other studies that demonstrated augmentation of cardiac natriuretic peptides by pharmacological -receptor blockade in humans. [7][8][9] However, the precise effect of the sympathetic nervous system on the natriuretic peptide system remains unclear.Therefore, we examined the effect of ETS of the second Circulation Journal Vol.69, September 2005and third thoracic sympathetic ganglia (Th2-3) on cardiac function and plasma ANP and brain natriuretic peptide (BNP) concentrations in patients with primary palmar hyperhidrosis to characterize the role of the sympathetic nervous system in the regulation of plasma natriuretic peptides. Methods Patient SelectionThirty-seven patients (19 males, 18 females, mean age 29±10 years; mean ± SD) underwent ETS for treatment of primary palmar hyperhidrosis. None had a history of cardiac disease nor were they receiving any drugs that could directly or indirectly modulate the autonomic nervous system. Written informed consent was obtained from all patients before enrollment. Study protocols were approved by the institutional committee on human research. ETSThe operative technique, which has previously been described in detail, 8,10 has been used in more than 600 patients with palmar hyperhidrosis at the Kanazawa Medical Center since 1993. Briefly, patients were intubated with an endotracheal tube under general anesthesia and placed in a semireclining position with both arms in abduction. The pleural cavity was accessed via a Surgineedle in the axillary fossa, and approximately 2 L of carbon dioxide was insufflated into the pleural cavity. A modified urological electroresectoscope was introduced via the same incision in the axillary fossa to visualize the upper thoracic cavity. The sympathetic chain was identified in the immediate vicinity of the cost- Effect of Endoscopic Transthoracic Sympathicotomy on Plasma Natriuretic Peptide Concentrations in HumansYukio Nakamura, MD; Hisashi Yoshizawa, MD; Motoaki Hirasawa, MD;Hiroshi Kida, MD; Yasushi Matsumoto, MD*; Takeshi Ueyama, MD* ...

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Effect of beta-adrenergic receptor blockade on atrial natriuretic peptide in essential hypertension.

Cited by 75 publications

References 27 publications

Neurohumoral Prediction of Benefit From Carvedilol in Ischemic Left Ventricular Dysfunction

Neurohumoral Prediction of Benefit From Carvedilol in Ischemic Left Ventricular Dysfunction

Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure

Effect of Endoscopic Transthoracic Sympathicotomy on Plasma Natriuretic Peptide Concentrations in Humans

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