B-type natriuretic peptides: looking to the future.
Whereas the role of the cardiac natriuretic peptides, ANP and BNP, in some aspects of physiology and pathophysiology is clear, their potential in diagnosis, prognosis, and therapeutics in many clinical disorders remains uncertain. We predict that circulating levels of these peptides will find increasing diagnostic utility in patients presenting with dyspnoea, in guiding the complex pharmacotherapy in heart failure, and may likewise be useful in guiding the management of patients on chronic maintenance renal dialysis. We predict also that levels of these peptides will be of practical use as prognostic indicators in 'at-risk' populations (such as those with diabetes, coronary heart disease, hypertension, thalassaemia, etc.) but probably not in the general population. It appears likely that administration of these peptides will find a place in the therapeutics of acute myocardial infarction, but this is less clear for heart failure. We describe the presence of a segment of the signal peptide for BNP within the circulation and discuss its potential clinical utility.
Department of Medicine, University of Otago Christchurch, Christchurch Hospital, Christchurch, New Zealand.
Richard W
RW
Troughton
Lynley K
LK
Lewis
Timothy G
TG
Yandle
Christopher J
CJ
Pemberton
M Gary
MG
Nicholls
D000818:Animals; D009320:Atrial Natriuretic Factor / Q000378:metabolism / Q000627:therapeutic use; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000378:metabolism / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor