Atrial natriuretic factor: Physiologic actions and implications in congestive heart failure

Abstract

Atrial natriuretic factor (ANF) represents a newly recognized hormone of cardiac origin. This peptide is synthesized by the myocardial cells of both atria and released by atrial stretch. The hormone promotes sodium and water excretion by the kidney, inhibits the renin-angiotensin-aldosterone system, and reduces systemic arterial pressure. Specific receptors for ANF are present in the kidney, adrenal glands, vascular smooth muscle, platelets and central nervous system. Congestive heart failure is characterized by increased circulating levels of ANF; however, there appears to be an attenuation in the renal response to the hormone. Recent investigations have reported the effect of systemic administration of synthetic ANF to normal individuals and those with congestive heart failure. The hormone may promote a significant natriuresis and diuresis in addition to reducing arterial pressure and inhibiting renin and aldosterone secretion. Substantial questions remain as to the full physiologic significance and therapeutic potential of this hormone.

Neprilysin inhibition to treat heart failure: a tale of science, serendipity, and second chances

“…Ever since de Bold and colleagues demonstrated that atrial extracts stimulated urinary sodium and water excretion, and the subsequent identification and characterization of the natriuretic peptides, there has been interest in harnessing the potential benefits of augmenting endogenous neurohumoral systems that are diuretic, natriuretic, vasodilating, and able to inhibit pathological growth (e.g. hypertrophy and fibrosis) in heart failure . Conceptually, such an approach is complementary to inhibition of the detrimental antinatriuretic, vasoconstrictor, and pathological growth‐promoting systems (such as the renin–angiotensin–aldosterone and sympathetic nervous systems), a strategy that has proved marvellously successful and which forms the fundamental basis of the current pharmacological therapy for heart failure with reduced left ventricular ejection fraction (HF‐REF) ( Figure ) .…”

What constitutes optimal neurohumoral antagonism in chronic heart failure?

“…Natriuretic peptides such as atrial natriuretic peptide (ANP) and BNP are central in mediating adaptive natriuretic and diuretic effects in chronic HF, and are thought to be released as a result of the pressure and stretch exerted on the atria and ventricles due to increased filling pressures 53 54. While the theoretical benefits of natriuretic peptides were identified more than 30 years ago,9 the results from clinical trials have not been convincing.…”

Arginine vasopressin (AVP) and treatment with arginine vasopressin receptor antagonists (vaptans) in congestive heart failure, liver cirrhosis and syndrome of inappropriate antidiuretic hormone secretion (SIADH)

“…These sodium-and volume retaining mechanisms are counter-balanced by the enhancement of the vasodilatory, natriuretic hormonal or cytokine systems, including the natriuretic peptides, prostaglandins, bradykinin and nitric oxide [17,18].…”