Natriuretic peptides in the treatment of heart failure

This study was designed to examine the hemodynamic, renal, and hormonal effects of infusion of A-type natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with congestive heart failure (CHF).

We infused synthetic human ANP or BNP at a rate of 0.1 microgram/kg/ min in 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 +/- 4 mL/m2; BNP: from 26 +/- 4 to 32 +/- 4 mL/m2, 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 +/- 389 microEq/min, P = NS; BNP: from 77 +/- 21 to 754 +/- 108 microEq/min, P < .01) and chloride (ANP: from 61 +/- 31 to 470 +/- 369 microEq/min, P = NS, BNP; from 74 +/- 20 to 709 +/- 103 microEq/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.

We conclude that ANP and BNP infusion improves left ventricular function in patients with CHF by vasodilation and prominent natriuretic action.