Measurement and significance of circulating natriuretic peptides in cardiovascular disease

Abstract

1. The major cardiovascular and renal actions of alpha-atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and the fact that the heart is strategically located to sense changes in intravascular volume indicate the importance of these peptides in the overall control of the extracellular fluid volume under normal and pathophysiological conditions.2. This review examines the clinical and diagnostic significance of the measurement of plasma natriuretic peptides in diseases of the cardiovascular system with particular emphasis on the assessment of patients with heart failure. 3. Raised plasma levels of ANP and BNP have repeatedly been found in patients with heart disease originating from diverse causes including tachycardias, valvular stenosis or ventricular dysfunction. The raised circulating levels of natriuretic peptide (ANP, N-terminal proANP and BNP in particular) are associated with (i) raised atrial and pulmonary wedge pressures; (ii) reduced ventricular systolic and diastolic function; (iii) presence (and possibly geometric form) of left ventricular hypertrophy; and (iv) severe myocardial infarction. Although both plasma ANP and BNP are raised in the presence of left ventricular hypertrophy, BNP appears to be a better index of left ventricular hypertrophy.4. Several situations where the measurement of natriuretic peptides may be of benefit in the overall assessment of heart disease are discussed. However, it is emphasized that the measurement of plasma natriuretic peptides alone appears to be of limited value as a specific diagnostic tool, given that raised levels are a consequence of haemodynamic and structural abnormalities arising from diverse pathological processes. Despite these limitations, the major value of plasma natriuretic peptides in the examination of patients with suspected heart disease rests on the premise that: (i) a normal value would not be consistent with cardiac disease; (ii) the presence of markedly raised levels may help to target those for subsequent detailed assessment of underlying cardiac dysfunction; and (iii) markedly raised levels of plasma natriuretic peptides after myocardial infarction can identify those at high risk of death.

Does B-Type Natriuretic Peptide Predict the New Onset of Hypertension?

“…Indeed, in the present study, BNP levels at baseline were slightly, but significantly, increased in subjects with pre-hypertension as compared to those with lower blood pressure. Most reports demonstrated that plasma BNP levels are increased in patients with hypertension as compared to normotensive subjects (8)(9)(10)(11)23), although the circadian rhythm of blood pressure may affect BNP levels (24). These observations are also compatible with our interpretation.…”

“…Indeed, circulating levels of the peptide are elevated in various cardiac disorders such as cardiomyopathy (5), previous myocardial infarction (6), and valvular diseases (7). BNP is also elevated in subjects with hypertension (8)(9)(10)(11). Since BNP levels were independently associated with blood pressure after adjustment for left ventricular mass index in patients with hypertension (11), an increase in blood pressure per se may stimulate the secretion of BNP through an increase in left ventricular wall stress.…”

Comparison of Enzymatic Recycling Electrodes for Measuring Aminophenol: Development of a Highly Sensitive Natriuretic Peptide Assay System

“…[1][2][3] Since the plasma levels of ANP and BNP increase in accordance with the severity of heart failure, measuring these peptides is very useful in both the diagnosis and the treatment of heart failure. [4][5][6][7][8][9][10] The concentrations of ANP and BNP in our blood under normal conditions are extremely low (< 40 pg mL -1 (ppt)), but rise to by 10 -100 fold in patients with severe congestive heart failure. 11,12 To measure such low concentrations of peptides, recearchers have developed and commercialized highly-sensitive radioimmunoassays or enzyme immunoassays based on chemiluminescence or fluorescence.…”

Ventricular natriuretic peptide (BNP) in heart transplantation: BNP correlation with endomyocardial biopsy, laboratory and hemodynamic measures

“…8,9 BNP is known to have natriuretic, diuretic and vasorelaxant properties; may have antagonistic effects on the rennin-angiotensin-aldosterone system; 8,10,11 and plays an important role in fluid homeostasis and blood pressure. [11][12][13][14] Atrial natriuretic peptide (ANP) and BNP have similar properties, but the half-life of BNP is five-to six-fold longer, and BNP is mainly secreted from the ventricles in the heart, whereas ANP mainly derives from the atria. [15][16][17] There is great interest in the diagnostic use of BNP for detection of ventricular dysfunction.…”