Atrial natriuretic factor: implications in congestive heart failure and hypertension

The physiological actions of the atrial peptide system are discussed in relation to its potential role in the aetiology and treatment of hypertension and congestive heart failure (CHF). Atrial natriuretic factor (ANF) exerts marked natriuretic, diuretic and vasodilatory effects and has been demonstrated to reduce blood pressure by several mechanisms, actions which serve to protect the central circulation against volume and pressure overload. It was initially believed that CHF may relate to a deficiency of ANF, but studies of experimentally induced and human CHF have shown elevated levels of circulating ANF, reflecting a compensatory increase in response to reduced cardiac output. In contrast, plasma levels of ANF in hypertension not complicated by CHF are normal and it might be speculated that hypertension reflects an attenuated ANF response to increase cardiac volume and/or pressure. ANF may play an important role in these cardiovascular disease states and, with the availability of synthetic ANF analogues, may also have therapeutic potential.