From the Guidelines
Atrial Natriuretic Peptide (ANP) plays a crucial role in managing heart failure by promoting sodium and water excretion, reducing blood pressure, and counteracting harmful neurohormonal systems.
Role of ANP in Heart Failure
ANP is a hormone naturally produced by the heart's atrial cells in response to stretching caused by increased blood volume. In heart failure patients, synthetic ANP analogs like carperitide and nesiritide can be administered to augment these beneficial effects. These medications work by binding to natriuretic peptide receptors, increasing cyclic GMP production, which leads to vasodilation of blood vessels, increased glomerular filtration rate in the kidneys, and inhibition of the renin-angiotensin-aldosterone system. This results in decreased cardiac preload and afterload, reduced pulmonary congestion, and improved symptoms like shortness of breath in acute decompensated heart failure. ANP also has anti-fibrotic and anti-hypertrophic effects on the heart, potentially slowing disease progression. However, these agents are typically reserved for hospitalized patients with acute heart failure rather than for chronic management, as their effects are relatively short-lived and require intravenous administration.
Key Points
- ANP promotes sodium and water excretion, reducing blood pressure and counteracting harmful neurohormonal systems 1.
- Synthetic ANP analogs can be used to manage heart failure, particularly in acute decompensated heart failure 1.
- ANP has anti-fibrotic and anti-hypertrophic effects on the heart, potentially slowing disease progression 1.
- Blood natriuretic peptide testing can be used to confirm the diagnosis of heart failure, particularly in patients with ambiguous or confounding symptoms 1.
Clinical Use
The use of ANP and its analogs in clinical practice is guided by the latest evidence and guidelines. For example, the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults recommends the use of natriuretic peptides as emerging markers of prevalent CVD 1. The 2007 National Academy of Clinical Biochemistry laboratory medicine practice guidelines recommend the use of BNP or NT-proBNP for confirmation of the heart failure diagnosis 1. The 2015 BMJ study on the diagnostic accuracy of natriuretic peptides in heart failure found that B-type natriuretic peptide and N-terminal probrain natriuretic peptide have excellent ability to exclude the diagnosis of acute heart failure at their respective lower cut-off thresholds 1.
Recommendation
Based on the latest evidence, ANP and its analogs should be used in the management of acute decompensated heart failure, and blood natriuretic peptide testing should be used to confirm the diagnosis of heart failure in patients with ambiguous or confounding symptoms. This approach can help improve patient outcomes and reduce morbidity and mortality associated with heart failure. However, the use of ANP and its analogs should be guided by the latest evidence and guidelines, and should be individualized to each patient's specific needs and circumstances.
From the Research
ANP Functions in Managing Heart Failure
- Atrial Natriuretic Peptide (ANP) plays a crucial role in managing heart failure by promoting renal sodium and water excretion and stimulating vasodilation 2.
- ANP has an anti-hypertrophic function in the heart, which is independent of its systemic blood pressure-lowering effect 2.
- Variants in the human NPPA gene, encoding the ANP precursor, are associated with hypertension, stroke, coronary artery disease, heart failure (HF), and obesity 2.
Mechanisms of ANP in Heart Failure
- ANP regulates vascular function and is involved in the pathophysiology of several cardiovascular diseases, including hypertension and heart failure 3.
- The principal molecular mechanisms underlying regulation of vascular tone by ANP include the natriuretic peptide receptor type A/cyclic guanylate monophosphate, natriuretic peptide receptor type C, and nitric oxide system 3.
- ANP may represent an optimal therapeutic agent in cardiovascular diseases due to its vasomodulatory properties 3.
Therapeutic Implications of ANP
- Recombinant proteins and small molecules that enhance the ANP pathway have been developed to treat patients with HF 2.
- ANP and related peptides are used as biomarkers for heart disease 2.
- The use of ANP analogues, neutral endopeptidase (NEP) inhibitors, ACE/NEP inhibitors, angiotensin receptor blocker (ARB)/NEP inhibitors, and dual endothelin-converting enzyme (ECE)/NEP inhibitors may have therapeutic implications in hypertension and heart failure 3.
Comparison with Other Treatments
- Nesiritide, a synthetic peptide homologous to endogenous BNP, has been shown to produce a potent, dose-related vasodilator effect that is rapid in onset and sustained during infusion 4, 5.
- Nesiritide compares favorably to standard agents in the treatment of decompensated HF, with a safety profile that includes dose-dependent hypotension as the major side effect 4, 5.