Natriuretic peptides in the treatment of heart failure

Abstract

Background: This study was designed to examine the hemodynamic, renal, and hormonaleffects of infusion of A-type natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with congestive heart failure (CHF). Methods and Results: We infused synthetic human ANP or BNP at a rate of 0.1 μg/kg/minin patients with CHF and control subjects. ANP and BNP infusion decreased pulmonary capillary wedge pressure (ANP: from 24 ± 1 to 12 ± 2 mmHg; BNP: from 21 ± 3 to 14 ± 4 mmHg, P < .01, respectively) and systemic vascular resistance (ANP: from 2,129 ± 293 to 1,737 ± 293 dyne·sec·cm −5; BNP: from 2,485 ± 379 to 1,771 ± 195 dyne·sec·cm −5, P < .01, respectively), and increased stroke volume index (ANP: from 26 ± 4 to 32 ± 4mL/M 2; BNP: from 26 ± 4 to 32 ± 4mL/m 2, P < .01, respectively) in patients with CHF. ANP and BNP infusion increased urine volume (ANP: from 0.7 ± 0.3 to 4.5 ± 3.3 mL/min, BNP; 0.8 ± 0.2 to 5.3 ± 1.0 mL/min, P < .01, respectively), excretion of sodium (ANP: from 53 ± 26 to 478 ± 389μEq/min, P = NS; BNP: from 77 ± 21 to 754 ± 108μEq/min, P < .01) and chloride (ANP: from 61 ± 31 to 470 ± 369 μEq/min, P = NS, BNP; from 74 ± 20 to 709 ± 103 μEq/min, P < .01) in patients with CHF. In the hormonal analysis, ANP and BNP infusion had inhibitory effects on reninangiotensin aldosterone system and the sympathetic nervous system. Conclusion: We conclude that ANP and BNP infusion improves left ventricular function in patients with CHF by vasodilation and prominent natriuretic action.