Atrial natriuretic peptide and brain natriuretic peptide in cor pulmonale. Hemodynamic and endocrine effects.
We have studied the hemodynamic and hormonal effects of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in eight patients with cor pulmonale. Subjects were studied twice and were given a 20-min placebo infusion followed by either ANP or BNP (3 pmol/kg/min then 10 pmol/kg/ min for 20 min each). Responses were measured after placebo infusion and following low-dose then high-dose ANP or BNP. Placebo infusion had no significant effects on either study day. Low-dose ANP and BNP significantly reduced mean pulmonary artery pressure (MPAP) from baseline by 3.7 mm Hg (95% confidence interval [CI], 1.4 to 6.1) and 3.0 mm Hg (95% CI, 0.6 to 5.4), respectively. High-dose ANP and BNP further reduced MPAP from baseline by 7.1 mm Hg (95% CI, 4.8 to 9.4) and 7.1 mm Hg (95% CI, 4.7 to 9.6), respectively. Effects on total pulmonary vascular resistance were similar. ANP and BNP had no confounding systemic hemodynamic effects. Plasma aldosterone was significantly suppressed from baseline by ANP: 156 pmol/L (95% CI, 93 to 220) after low dose, 275 pmol/L (95% CI, 207 to 343) after high dose; and by BNP: 92 pmol/L (95% CI, 30 to 153) after low dose, 159 pmol/L (95% CI, 98 to 220) after high dose. ANP and BNP produced dose-related pulmonary vasodilatation in patients with cor pulmonale, without worsening oxygen saturation or affecting systemic hemodynamics. ANP and BNP also exerted favorable neurohormonal effects by suppressing aldosterone.
Department of Clinical Pharmacology, University of Dundee, Scotland.
R I
RI
Cargill
B J
BJ
Lipworth
D000450:Aldosterone / Q000097:blood*; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D003864:Depression, Chemical; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010919:Placebos; D011651:Pulmonary Artery / Q000187:drug effects; D011660:Pulmonary Heart Disease / Q000188:drug therapy*; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000451:Mineralocorticoid Receptor Antagonists; D009419:Nerve Tissue Proteins; D010919:Placebos; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D010100:Oxygen