Abstract-Plasma concentrations of the recently discovered hormones adrenomedullin (ADM), from vascular tissue, and brain natriuretic peptide (BNP), secreted by myocardium, are elevated in patients with heart failure. We tested the hypotheses that short-term increments in circulating levels of these hormones, within the pathophysiological range, would have biological effects and that the 2 hormone systems interact. Eight patients with heart failure (left ventricular ejection fractions Ͻ35%) received 4-hour infusions of BNP (3.0 pmol ⅐ kg Ϫ1 ⅐ min Ϫ1 ) alone, ADM (2.7 pmol ⅐ kg Ϫ1 ⅐ min Ϫ1 and 5.4 pmol ⅐ kg Ϫ1 ⅐ min Ϫ1 for 2 hours each) alone, ADM and BNP combined, and placebo. BNP and ADM infusions raised plasma levels of the respective peptide within the pathophysiological range. Arterial blood pressure fell (PϽ0.05) with all peptide infusions, but cardiac output was unchanged. Heart rate increased with ADM and combined infusions (PϽ0.01). Sodium excretion rose (PϽ0.05), and creatinine clearance was sustained during both BNP and combined infusions. Urine volume increased in response to BNP alone (Pϭ0.02). Despite a Ͼ2-fold increase in plasma renin with both ADM and combined infusions (PϽ0.05), plasma aldosterone remained lower than time-matched placebo levels. Plasma noradrenaline was increased by combined, BNP, and higher dose ADM infusions (PϽ0.05). ADM suppressed plasma cGMP (PϽ0.05) and inhibited the plasma cGMP response to BNP (PϽ0.05). The vascular hormones ADM and BNP, produced by myocardium, at plasma concentrations within the pathophysiological range have hemodynamic, renal, and hormonal effects and measurable interactions in patients with heart failure. (Hypertension. 1999;34:70-75.) Key Words: heart failure Ⅲ adrenomedullin Ⅲ natriuretic peptides Ⅲ arterial pressure N eurohormonal activation plays a crucial role in the pathophysiology of heart failure. 1 Adrenomedullin (ADM), discovered in 1993, 2 and brain natriuretic peptide (BNP) are peptides with vasodilator, natriuretic, and aldosterone-inhibitory actions. 3-5 Plasma levels of both peptides are increased in proportion to the degree of hemodynamic compromise. 6,7 BNP is secreted predominantly from the left ventricle in response to increases in wall stress, whereas production of ADM from cultured endothelial and vascular smooth muscle cells suggests that blood vessels may be a major source of circulating ADM. 8,9 It is likely that ADM functions in an autocrine or paracrine fashion in addition to any role it may have as a circulating hormone because tissues with ADM receptors are also those with ADM synthetic capability. 10,11 Preliminary data suggest that there may be interactions between ADM, produced primarily in the peripheral circulation, and the cardiac natriuretic peptides produced in the heart. 12,13 Currently, however, there is no information regarding the effects of infused ADM in patients with heart failure and no data directly comparing the biological actions of ADM and BNP. Furthermore, the effects of coadministration of ADM and BNP in ...