title: Endogenous B-type natriuretic peptide: a limb of the regulatory response to acutely decompensated heart failure.
abstract: Acutely decompensated heart failure (ADHF) represents an episodic failure of cardiorenal homeostasis that may resolve with upregulation of natriuretic peptides, bradykinin, and certain prostacyclins. B-type natriuretic peptide (BNP) has multiple favorable effects, including vasodilation, diuresis, natriuresis, and inhibition of vascular endothelial proliferation and cardiac fibrosis. By antagonizing the effects of activation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system in volume overload, the endogenous BNP response may help rescue patients from episodic ADHF. Although knowledge of BNP physiology is expanding, we still have limited understanding of the heterogeneity of proBNP-derived molecules, including active 32 amino acid BNP and less active junk BNP forms. Emerging evidence suggests that in ADHF, the endogenous BNP response is overwhelmed by neurohormonal activation. This relative BNP deficiency may also be accompanied by physiologic resistance to BNP. Additionally, abnormalities of BNP production may result in a lower proportion of active BNP relative to less active forms that may also be detected by point-of-care tests. Improved detection of the various BNP species may clarify these concepts and facilitate improved clinical management of ADHF.
authors.affiliation: Section of Heart Failure and Transplant Medicine, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. hobbsr@ccf.org
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hobbs
authors.forename: Roger M
authors.initials: RM
authors.lastname: Mills
mesh_terms: D002320:Cardiovascular Physiological Phenomena; D002319:Cardiovascular System / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000502:physiology*; D012084:Renin-Angiotensin System / Q000502:physiology; D013564:Sympathetic Nervous System / Q000502:physiology
chemical_list: D020097:Natriuretic Peptide, Brain
references.citation: Crit Pathw Cardiol. 2005 Mar;4(1):10-20
references.pmid: 18340179
references.citation: Clin Chem. 2004 Sep;50(9):1503-10
references.pmid: 15265821
references.citation: Rev Cardiovasc Med. 2003 Spring;4(2):72-80
references.pmid: 12776016
references.citation: J Card Fail. 2006 Feb;12(1):e1-2
references.pmid: 16500560
references.citation: Can J Physiol Pharmacol. 2001 Aug;79(8):730-5
references.pmid: 11558682
references.citation: Expert Opin Investig Drugs. 2001 May;10(5):935-42
references.pmid: 11322867
references.citation: Arq Bras Cardiol. 2005 Sep;85 Suppl 3:49-94; 1-48
references.pmid: 16211166
references.citation: Expert Opin Investig Drugs. 2004 Jun;13(6):643-52
references.pmid: 15174950
references.citation: Pharmacol Ther. 2004 Feb;101(2):113-29
references.pmid: 14761702
references.citation: Am Heart J. 2003 Feb;145(2 Suppl):S18-25
references.pmid: 12594448
references.citation: Clin Chim Acta. 2003 Aug;334(1-2):233-9
references.pmid: 12867297
references.citation: Proc Assoc Am Physicians. 1999 Sep-Oct;111(5):406-16
references.pmid: 10519161
references.citation: Mt Sinai J Med. 2006 Mar;73(2):506-15
references.pmid: 16568193
references.citation: Life Sci. 1997;61(12):1185-92
references.pmid: 9315509
references.citation: Circ Res. 1994 Mar;74(3):471-6
references.pmid: 8118955
references.citation: N Engl J Med. 2002 Jul 18;347(3):161-7
references.pmid: 12124404
references.citation: Am Heart J. 2003 Feb;145(2 Suppl):S34-46
references.pmid: 12594450
references.citation: Eur Heart J. 2005 Feb;26(4):384-416
references.pmid: 15681577
references.citation: Circulation. 2003 Dec 16;108(24):2964-6
references.pmid: 14662703
references.citation: Am J Physiol. 1998 May;274(5):H1684-9
references.pmid: 9612380
references.citation: J Am Coll Cardiol. 2007 Mar 13;49(10):1071-8
references.pmid: 17349887
references.citation: Trends Endocrinol Metab. 2003 Nov;14(9):411-6
references.pmid: 14580760
references.citation: Am J Physiol Regul Integr Comp Physiol. 2007 Feb;292(2):R897-901
references.pmid: 17068158
references.citation: Proc Natl Acad Sci U S A. 2005 Nov 29;102(48):17442-7
references.pmid: 16293687
references.citation: Clin Chim Acta. 2002 Feb;316(1-2):129-35
references.pmid: 11750283
references.citation: Circ Res. 2003 Oct 17;93(8):700-9
references.pmid: 14563709
references.citation: Curr Opin Nephrol Hypertens. 2006 Jan;15(1):14-21
references.pmid: 16340661
references.citation: Curr Cardiol Rep. 2000 May;2(3):198-205
references.pmid: 10980893
references.citation: Hypertension. 2007 May;49(5):1114-9
references.pmid: 17372040
references.citation: Fundam Clin Pharmacol. 2005 Aug;19(4):411-9
references.pmid: 16011727
references.citation: Pharmacotherapy. 2003 Aug;23(8):997-1020
references.pmid: 12921247
references.citation: J Am Coll Cardiol. 2007 Mar 13;49(10):1079-88
references.pmid: 17349888
references.citation: Proc Natl Acad Sci U S A. 2000 Apr 11;97(8):4239-44
references.pmid: 10737768
references.citation: Am Heart J. 2005 Apr;149(4):744-50
references.pmid: 15990762
references.citation: Curr Med Chem Cardiovasc Hematol Agents. 2005 Apr;3(2):87-98
references.pmid: 15853696
references.citation: Clin Sci (Lond). 2005 Jan;108(1):23-36
references.pmid: 15476436
references.citation: Can J Physiol Pharmacol. 2001 Aug;79(8):705-14
references.pmid: 11558679
references.citation: Rev Cardiovasc Med. 2004;5 Suppl 4:S3-16
references.pmid: 15627917
references.citation: J Am Coll Cardiol. 2007 Mar 13;49(10):1089-91
references.pmid: 17349889