The role of natriuretic peptides in heart failure

Abstract

Heart failure is a clinical syndrome associated with progressive cardiac, vascular, and renal dysfunction. Regardless of the initial injury, investigations have demonstrated that neurohormones play an important role in the complex multiorgan and cellular adaptations. Natriuretic peptides play a key role in this process, antagonizing the actions of the renin-angiotensin-aldosterone system, thus promoting vasodilatation and natriuresis. Other important physiologic properties of the natriuretic peptides are prolusitropic, sympathoinhibitory, antiproliferative, anti-ischemic, anti-inflammatory, and antioxidative. Administering exogenous natriuretic peptide is a US Food and Drug Administration-approved therapy for patients with advanced decompensated congestive heart failure. Also, measuring natriuretic peptide levels has diagnostic and prognostic value. More studies are needed to define the full potential of this unique family of endogenous peptides.

Role of Angiotensin Receptor-Neprilysin Inhibition in Heart Failure

“…In the setting of volume expansion or pressure overload, release of BNP results in improved myocardial relaxation and opposes the vasoconstriction, sodium retention, and antidiuretic effects of the RAAS [15,16]. NPs reduce renin release from the renal juxtaglomerular cells, decreasing Ang II [17,18].…”

Neprilysin Inhibition in Heart Failure with Reduced Ejection Fraction: A Clinical Review

“…The activation and release of NPs as a HFrEF compensatory mechanism requires special attention in this review. NPs are a group of hormones whose stimulation and release is primarily due to the effects of RAAS activation, fluid retention, increased preload, and vasoconstriction . Through multiple mechanisms, NPs protect CV health by balancing the effects of the RAAS through natriuresis, diuresis, vasodilation, decreased aldosterone secretion, inhibition of sympathetic stimulation, and a protective effect against myocardial fibrosis .…”

Proteomic Biomarkers of Heart Failure

“…It is a central component in cardiovascular homeostasis and is released from the cardiomyocytes, primarily located in the ventricles, in response to stress and stretch of the cardiac muscle (31). After binding to specific receptors, BNP is activated and drives a reduction in systemic vascular resistance, antagonizes the actions of the renin-angiotensinaldosterone system (RAAS), and promotes vasodilation and natriuresis (32). BNP has been studied extensively for its role as a diagnostic (33)(34)(35) and prognostic (36)(37)(38) biomarker in HF, including both chronic patients and acute decompensated admissions.…”