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Contempo 1998
December 16, 1998

Natriuretic Peptides—Relevance in Cardiovascular Disease

Author Affiliations

From the Department of Medicine, University of Hong Kong, Hong Kong, China. Dr Kumana is a member of the JAMA International Advisory Committee and editorial director of JAMA Southeast Asia.

JAMA. 1998;280(23):1983-1984. doi:10.1001/jama.280.23.1983

THE FAMILY of natriuretic peptides, which includes atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP), has a regulatory and modulatory role in the cardiovascular system.1,2 ANP and BNP are circulating cardiac hormones. ANP is synthesized by myocytes mainly in the atria and stored in granules. BNP, also known as brain natriuretic peptide because it was first isolated from porcine brain, is synthesized primarily by cardiac myocytes in the ventricles and is not stored to the same extent as ANP. The nucleic acid sequence of the BNP gene contains the destabilizing sequence TATTTAT, which suggests that the turnover of BNP messenger RNA (mRNA) is high and that BNP is synthesized in bursts. In response to stretching of the right atrium by increased venous pressure, stored ANP is immediately released from atrial granules, whereas an increase in BNP secretion is preceded by an increase in mRNA.3 Thus, intravenous saline loading increases plasma ANP acutely, but there is no corresponding immediate increase in plasma BNP.4 In contrast, the increase in intravascular volume from dietary salt loading results in the expected increase in BNP.4 Similarly, a change in a patient's pacemaker mode from atrial to ventricular pacing leading to uncoordinated atrial contractions and high pressure waves causes a greater acute increase in plasma ANP than BNP.5 It therefore appears that BNP level reflects long-term intravascular volume status rather than momentary volume. Moreover, BNP is more stable than ANP in plasma and has a longer half-life,6 which may be attributable to its lesser affinity for clearance receptors. CNP is synthesized in the endothelium and has vasodilatory and antiproliferative effects on vascular smooth muscle. It has a local action in the blood vessels or within the organ where it is produced.

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