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Díez J. Chronic heart failure as a state of reduced effectiveness of the natriuretic peptide system: implications for therapy. Eur J Heart Fail. 2016;19(2):167-176doi: 10.1002/ejhf.656.
Díez, J. (2017). Chronic heart failure as a state of reduced effectiveness of the natriuretic peptide system: implications for therapy. European journal of heart failure, 19(2), 167-176. https://doi.org/10.1002/ejhf.656
Díez, Javier. "Chronic heart failure as a state of reduced effectiveness of the natriuretic peptide system: implications for therapy." European journal of heart failure vol. 19,2 (2017): 167-176. doi: https://doi.org/10.1002/ejhf.656
Díez J. Chronic heart failure as a state of reduced effectiveness of the natriuretic peptide system: implications for therapy. Eur J Heart Fail. 2017 Feb;19(2):167-176. doi: 10.1002/ejhf.656. Epub 2016 Oct 21. PMID: 27766748; PMCID: PMC5297869.
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Eur J Heart Fail. 2017 Feb;19(2):167-176. doi: 10.1002/ejhf.656. Epub 2016 Oct 21.

Chronic heart failure as a state of reduced effectiveness of the natriuretic peptide system: implications for therapy.

European journal of heart failure

Javier Díez

Affiliations

  1. Program of Cardiovascular Diseases, Centre for Applied Medical Research, and Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain.

PMID: 27766748 PMCID: PMC5297869 DOI: 10.1002/ejhf.656

Abstract

Natriuretic peptides (NPs) promote diuresis, natriuresis and vasodilation in early chronic heart failure (CHF), countering renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) overstimulation. Despite dramatic increases in circulating NP concentrations as CHF progresses, their effects become blunted. Increases in diuresis, natriuresis, and vasodilation after administration of exogenous atrial (ANP) or brain (BNP) natriuretic peptides are attenuated in patients with advanced CHF compared with controls. Several major factors may account for the reduced effectiveness of the natriuretic peptide system (NPS) in CHF. First, there is reduced availability of active forms of NPs, namely BNP. Second, target organ responsiveness becomes diminished. Third, the counter-regulatory hormones of the RAAS and SNS, and endothelin-1 become over-activated. Therefore, pharmacological approaches to enhance the functional effectiveness of the NPS in CHF have been explored in recent years. In terms of clinical outcomes, studies of synthetic BNP, or of neprilysin inhibitors alone or associated with an angiotensin converting enzyme inhibitor, have been controversial for several reasons. Recently, however, encouraging results have been obtained with the angiotensin receptor neprilysin inhibitor sacubitril/valsartan. The available data show that treatment with sacubitril/valsartan is associated with increased levels of NPs and their intracellular mediator cyclic guanosine monophosphate, suggesting improved functional effectiveness of the NPS, in addition to beneficial effects on mortality and morbidity outcomes. Therefore, combined targeting of the NPS and RAAS with sacubitril/valsartan emerges as the current optimal approach for redressing the neurohormonal imbalance in CHF.

© 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords: Atrial natriuretic peptide; Brain natriuretic peptide; Heart failure; Natriuretic peptide; Neprilysin

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