Vascular and renal actions of brain natriuretic peptide in man: physiology and pharmacology

Abstract

During the last decade brain natriuretic peptide (BNP) has received increasing attention as a potential marker of cardiovascular disease. BNP may act as a compensating mechanism in cardiovascular diseases in order to reduce preload. However, the increase in endogenous BNP is often not sufficient to compensate for volume overload in diseases like established hypertension and heart failure. The reported hemodynamic and renal effects of BNP in man differ largely between studies, because of differences in design and doses of BNP employed. In the pharmacological range, BNP has clear blood pressure and afterload lowering effects, and in the kidney blood flow and filtration is increased with concomitant natriuresis and diuresis. While in the physiological range BNP does not affect blood pressure and reduces preload only, and induces natriuresis/diuresis without changes in renal blood flow and filtration. There is increasing evidence from vascular studies that BNP preferentially acts on the venous system resulting in preload reduction, in contrast to atrial natriuretic peptide which acts preferentially on the arterial system to reduce afterload. This review summarizes our current understanding of BNP, and discuss its regulation and mechanisms of action on the vasculature and the kidneys.

The atrial natriuretic peptide- and catecholamine-induced lipolysis and expression of related genes in adipose tissue in hypothyroid and hyperthyroid patients

“…The ethanol ratio decreased during ANP and isoprenaline perfusion, suggesting an increase in local blood flow consecutive to vasodilatation. These data are congruent with findings of other studies documenting direct vasodilating effect of ANP (12,23). In addition, it cannot be excluded that, in addition to the direct ANP effect, the higher lipolytic response in hyperthyroid subjects, releasing more metabolic products such as adenosine, may induce the higher vasodilatation.…”

Clinical applications of N-terminal pro B-type natriuretic peptide in heart failure and other cardiovascular diseases

“…In the kidneys, BNP may result in an increase in renal blood flow and glomerular filtration rate through afferent arteriolar vasodilation and efferent arteriolar vasoconstriction, ultimately promoting both diuresis and natriuresis [20]. These physiologic properties of BNP were the rationale for developing this molecule to treat acute heart failure syndromes (AHFS) [21].…”

Relationship and Clinical Usefulness between Preoperative Levels of Brain Natriuretic Peptide, Other Cardiac Markers and Perioperative Parameters in Patients with Coronary Artery Disease

“…In the kidneys, BNP increases glomerular filtration and renal blood flow via increased efferent arteriolar and decreases the afferent arteriolar tone as well as the renin release and sodium reabsorption, ultimately resulting in both diu- resis and natriuresis [13]. Because of such characteristics of BNP, earlier studies focused on its elevation following congestive heart failure.…”