Abstract-In experimental animals, C-type natriuretic peptide (CNP) has vasodilating, hypotensive, and natriuretic activities.The role of circulating CNP in the overall regulation of cardiac and renal function in humans is less defined, in both health and disease. We measured cardiac volumes, diastolic and systolic functions, systemic (Doppler echocardiography) and renal hemodynamics, intrarenal sodium handling (lithium clearance method), plasma and urinary cGMP, plasma renin concentration, and plasma aldosterone level in six healthy volunteers (mean age, 33Ϯ3 years) receiving CNP (2 and 4 pmol/kg per minute for 1 hour each) in a single-blind, placebo-controlled, random-order, crossover study. During CNP infusion, plasma CNP increased from 1.17Ϯ0.23 to 41.52Ϯ4.61 pmol/L (ie, 4-to 10-fold higher levels than those observed in disease states) without affecting plasma and urinary cGMP, cardiac volumes, dynamics of left and right heart filling, cardiac output, arterial pressure, renal hemodynamics, intrarenal sodium handling, sodium excretion, or plasma levels of renin and aldosterone. The finding that increments in plasma CNP within the pathophysiological range have no effects on systemic hemodynamics, renal function, or the renin-angiotensin system do not support the hypothesis that CNP may act as a circulating hormone in humans. (Hypertension. 1998;31:802-808.)Key Words: echocardiography Ⅲ hemodynamics Ⅲ systole Ⅲ diastole Ⅲ natriuretic peptides T he natriuretic peptide system consists of at least three structurally homologous peptides: ANP, BNP, and CNP. ANP and BNP are cardiac hormones that contribute to the overall regulation of cardiovascular homeostasis and fluid volume due to their natriuretic, vasodilating, and renin-aldosterone-inhibiting actions.1,2 CNP, first isolated in porcine brain, 3 is a 22-amino acid peptide that shares a high homology with ANP and BNP within the ring structure but lacks the carboxyl-terminal extension.
3Outside the central nervous system, CNP is mainly produced by the vascular endothelium, [4][5][6] in which it is thought to act as a local paracrine factor for the control of vascular tone. Endothelial production of CNP is remarkably augmented by various cytokines and growth factors such as transforming growth factor- and tumor necrosis factor-␣, suggesting that CNP may be of pathophysiological relevance in various vascular disorders.7 Like the other natriuretic peptides, CNP is detectable in plasma of healthy subjects, although at much lower concentrations than ANP and BNP. 4,8 -13 Plasma CNP levels are increased in patients with chronic renal failure, 9,10 septic shock, 11 and cor pulmonale, 12 raising the possibility that CNP may be a circulating hormone involved in the regulation of cardiovascular function. CNP exerts its biological effects by selectively activating the NPR-B, 14,15 leading to an increase in cGMP in target cells. In experimental animals, the administration of CNP induces vasodilation of both arteries and veins 16 ; reduces cardiac filling pressures, 17 CO,18,1...