Skip to main content
SpringerLink
Log in

Brain natriuretic peptide and optimal management of heart failure

  • Published:
Journal of Zhejiang University Science B Aims and scope Submit manuscript

Abstract

Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease. Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spironolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guidance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Berger, R., Huelsman, M., Strecker, K., Bojic, A., Moser, P., Stanek, B., Pacher, R., 2002. Brain natriuretic peptide predicts sudden death in patients with chronic heart failure.Circulation,105(20):2392–2397.

    Article  PubMed  Google Scholar 

  • Brunner-La Rocca, H.P., Kaye, D.M., Woods, R.L., Hastings, J., Esler, M.D., 2001. Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects.J. Am. Coll. Cardiol.,37(5):1221–1227.

    Article  PubMed  CAS  Google Scholar 

  • Cao, L., Gardner, D.G., 1995. Natriuretic peptides inhibit DNA synthesis in cardiac fibroblasts.Hypertension,25(2):227–234.

    PubMed  CAS  Google Scholar 

  • Charles, C.J., Espiner, E.A., Richards, A.M., Nicholls, M.G., Yandle, T.G., 1996. Comparative bioactivity of atrial, brain, and C-type natriuretic peptides in conscious sheep.Am. J. Physiol.,270(6 Pt 2):R1324–1331.

    PubMed  CAS  Google Scholar 

  • Clarkson, P.B., Wheeldon, N.M., Macleod, C., Coutie, W., MacDonald, T.M., 1995. Brain natriuretic peptide: Effect on left ventricular filling patterns in healthy subjects.Clin. Sci. (Lond),88(2):159–164.

    CAS  Google Scholar 

  • Clarkson, P.B., Wheeldon, N.M., MacFadyen, R.J., Pringle, S.D., MacDonald, T.M., 1996. Effects of brain natriuretic peptide on exercise hemodynamics and neurohormones in isolated diastolic heart failure.Circulation,93(11): 2037–2042.

    PubMed  CAS  Google Scholar 

  • de Bold, A.J., 1985. Atrial natriuretic factor: A hormone produced by the heart.Science,230(4727):767–770.

    Article  PubMed  Google Scholar 

  • de Bold, A.J., Borenstein, H.B., Veress, A.T., Sonnenberg, H., 1981. A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats.Life Sci.,28(1):89–94.

    Article  PubMed  Google Scholar 

  • de Bold, A.J., Bruneau, B.G., Kuroski de Bold, M.L., 1996. Mechanical and neuroendocrine regulation of the endocrine heart,Cardiovasc. Res.,31(1):7–18.

    Article  PubMed  Google Scholar 

  • de Bold, A.J., Ma, K.K., Zhang, Y., de Bold, M.L., Bensimon, M., Khoshbaten, A., 2001. The physiological and pathophysiological modulation of the endocrine function of the heart.Can. J. Physiol. Pharmacol.,79(8):705–714.

    Article  PubMed  Google Scholar 

  • Fonarow, G.C., 2003. Brain natriuretic peptide: Spectrum of application. Nesiritide (recombinant BNP) for heart failure.Heart Fail Rev.,8(4):321–325.

    Article  PubMed  CAS  Google Scholar 

  • Fujisaki, H., Ito, H., Hirata, Y., Tanaka, M., Hata, M., Lin, M., Adachi, S., Akimoto, H., Marumo, F., Hiroc, M., 1995. Natriuretic peptides inhibit angiotensin II-induced proliferation of rat cardiac fibroblasts by blocking endothelin-1 gene expression.J. Clin. Invest.,96(2): 1059–1065.

    Article  PubMed  CAS  Google Scholar 

  • Hama, N., Itoh, H., Shirakami, G., Nakagawa, O., Suga, S., Ogawa, Y., Masuda, I., Nakanishi, K., Yoshimasa, T., Hashimoto, Y., 1995. Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction.Circulation,92(6):1558–1564.

    PubMed  CAS  Google Scholar 

  • Henry, J.P., Pearce, J.W., 1956. The possible role of cardiac atrial stretch receptors in the induction of changes in urine flow.J. Physiol.,131(3):572–585.

    PubMed  CAS  Google Scholar 

  • Hunt, P.J., Espiner, E.A., Richards, A.M., Yandle, T.G., Frampton, C., Nicholls, M.G., 1995. Interactions of atrial and brain natriuretic peptides at pathophysiological levels in normal men.Am. J. Physiol.,269(6 Pt 2):R1397–1403.

    PubMed  CAS  Google Scholar 

  • Hunt, S.A., Baker, D.W., Chin, M.H., Cinquegrani, M.P., Feldman, A.M., Francis, G.S., Ganiats, T.G., Goldstein, S., Gregoratos, G., Jessup, M.L.,et al., 2001. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines (committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure).J. Am. Coll. Cardiol.,38:2101–2113.

    Article  PubMed  CAS  Google Scholar 

  • Jensen, K.T., Carstens, J., Pedersen, E.B., 1998. Effect of BNP on renal hemodynamics tubular function and vasoactive hormones in humans.Am. J. Physiol.,274(1 Pt 2): F63-F72.

    PubMed  CAS  Google Scholar 

  • Kangawa, K., Fukuda, A., Kubota, I., Hayashi, Y., Minamitake, Y., Matsuo, H., 1984. Human atrial natriuretic polypeptides (hANP): Purification, structure synthesis and biological activity.J. Hypertens. Suppl.,2(3):S321-S323.

    Article  PubMed  CAS  Google Scholar 

  • Kikuta, K., Yasue, H., Yoshimura, M., Morita, E., Sumida, H., Kato, H., Kugiyama, K., Ogawa, H., Okumura, K., Ogawa, Y.,et al., 1996. Increased plasma levels of B-type natriuretic peptide in patients with unstable angina.Am. Heart J.,132(1 Pt 1):101–107.

    Article  PubMed  CAS  Google Scholar 

  • Kisch, B., 1956. Electron microscopy of the atrium of the heart. I. Guinea pig.Exp. Med. Surg.,14(2–3):99–112.

    PubMed  CAS  Google Scholar 

  • Koller, K.J., Goeddel, D.V., 1992. Molecular biology of the natriuretic peptides and their receptors.Circulation,86(4):1081–1088.

    PubMed  CAS  Google Scholar 

  • Kyriakides, Z.S., Markianos, M., Michalis, L., Antoniadis, A., Nikolaou, N.I., Kremastinos, D.T., 2000. Brain natriuretic peptide increases acutely and much more prominently than atrial natriuretic peptide during coronary angioplasty.Clin. Cardiol.,23(4):285–288.

    Article  PubMed  CAS  Google Scholar 

  • Lainchbury, J.G., Nicholls, M.G., Espiner, E.A., Yandle, T.G., Lewis, L.K., Richards, A.M., 1999. Bioactivity and interactions of adrenomedullin and brain natriuretic peptide in patients with heart failure.Hypertension,34(1):70–75.

    PubMed  CAS  Google Scholar 

  • Latini, R., Masson, S., Anand, I., Judd, D., Maggioni, A.P., Chiang, Y.T., Bevilacqua, M., Salio, M., Cardano, P., Dunselman, P.H.,et al., 2002. Effects of valsartan on circulating brain natriuretic peptide and norepinephrine in symptomatic chronic heart failure: The Valsartan Heart Failure Trial (Val-HeFT).Circulation,106(19):2454–2458.

    Article  PubMed  CAS  Google Scholar 

  • Lubien, E., DeMaria, A., Krishnaswamy, P., Clopton, P., Koon, J., Kazanegra, R., Gardetto, N., Wanner, E., Maisel, A.S., 2002. Utility of B-natriuretic peptide in detecting diastolic dysfunction: Comparison with Doppler velocity recordings.Circulation,105(5):595–601.

    Article  PubMed  CAS  Google Scholar 

  • Maisel, A.S., 2003. Nesiritide: A new therapy for the treatment of heart failure.Cardiovasc. Toxicol.,3(1):37–42.

    Article  PubMed  CAS  Google Scholar 

  • Maisel, A.S., Krishnaswamy, P., Nowak, R.M., McCord, J., Hollander, J.E., Duc, P., Omland, T., Storrow, A.B., Abraham, W.T., Wu, A.H.,et al., 2002. Breathing not properly multinational study investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.N. Engl. J. Med.,347(3): 161–167.

    Article  PubMed  CAS  Google Scholar 

  • Minamino, N., Makino, Y., Tateyama, H., Kangawa, K., Matsuo, H., 1991. Characterization of immunoreactive human C-type natriuretic peptide in brain and heart.Biochem. Biophys. Res. Commun.,179(1):535–542.

    Article  PubMed  CAS  Google Scholar 

  • Mukoyama, M., Nakao, K., Hosoda, K., Suga, S., Saito, Y., Ogawa, Y., Shirakami, G., Jougasaki, M., Obata, K., Yasue, H., 1991. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide.J. Clin. Invest.,87(4): 1402–1412.

    Article  PubMed  CAS  Google Scholar 

  • Murdoch, D.R., McDonagh, T.A., Byrne, J., Blue, L., Farmer, R., Morton, J.J., Dargie, H.J., 1999. Titration of vasodilator therapy in chronic heart failure according to plasma brain natriuretic peptide concentration: Randomized comparison of the hemodynamic and neuroendocrine effects of tailored versus empirical therapy.Am. Heart J.,138(6 Pt 1):1126–1132.

    Article  PubMed  CAS  Google Scholar 

  • Rademaker, M.T., Charles, C.J., Kosoglou, T., Protter, A.A., Espiner, E.A., Nicholls, M.G., Richards, A.M., 1997. Clearance receptors and endopeptidase: Equal role in natriuretic peptide metabolism in heart failure.Am. J. Physiol.,273(5 Pt 2):H2372–2379.

    PubMed  CAS  Google Scholar 

  • Richards, A.M., Crozier, I.G., Holmes, S.J., Espiner, E.A., Yandle, T.G., Frampton, C., 1993. Brain natriuretic peptide: Natriuretic and endocrine effects in essential hypertension.J. Hypertens.,11(2):163–170.

    Article  PubMed  CAS  Google Scholar 

  • Sanderson, J.E., Chan, W.W., Hung, Y.T., Chan, S.K., Shum, I.O., Raymond, K., Woo, K.S., 1995. Effect of low dose beta blockers on atrial and ventricular (B type) natriuretic factor in heart failure: A double blind, randomised comparison of metoprolol and a third generation vasodilating beta blocker.Br. Heart J.,74(5):502–507.

    Article  PubMed  CAS  Google Scholar 

  • Shiga, T., Hosaka, F., Wakaumi, M., Matsuda, N., Tanizaki, K., Kajimoto, K., Shoda, M., Hagiwara, N., Kasanuki, H., 2003. Amiodarone decreases plasma brain natriuretic peptide level in patients with heart failure and ventricular tachyarrhythmia.Cardiovasc. Drugs Ther.,17(4): 325–333.

    Article  PubMed  CAS  Google Scholar 

  • Sudoh, T., Kangawa, K., Minamino, N., Matsuo, H., 1988. A new natriuretic peptide in porcine brain.Nature,332(6159):78–81.

    Article  PubMed  CAS  Google Scholar 

  • Sudoh, T., Maekawa, K., Kojima, M., Minamino, N., Kangawa, K., Matsuo, H., 1989. Cloning and sequence analysis of cDNA encoding a precursor for human brain natriuretic peptide.Biochem. Biophys. Res. Commun.,159(3):1427–1434.

    Article  PubMed  CAS  Google Scholar 

  • Sudoh, T., Minamino, N., Kangawa, K., Matsuo, H., 1990. C-type natriuretic peptide (CNP): A new member of natriuretic peptide family identified in porcine brain.Biochem. Biophys. Res. Commun.,168(2):863–870.

    Article  PubMed  CAS  Google Scholar 

  • Suga, S., Nakao, K., Hosoda, K., Mukoyama, M., Ogawa, Y., Shirakami, G., Arai, H., Saito, Y., Kambayashi, Y., Inouye, K., 1992. Receptor selectivity of natriuretic peptide family, atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide.Endocrinology,130(1):229–239.

    Article  PubMed  CAS  Google Scholar 

  • Tateishi, J., Masutani, M., Ohyanagi, M., Iwasaki, T., 2000. Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty.Clin. Cardiol.,23(10):776–780.

    Article  PubMed  CAS  Google Scholar 

  • Troughton, R.W., Frampton, C.M., Yandle, T.G., Espiner, E.A., Nicholls, M.G., Richards, A.M., 2000. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations.Lancet.,355(9210):1126–1130.

    Article  PubMed  CAS  Google Scholar 

  • Tsutamoto, T., Wada, A., Maeda, K., Hisanaga, T., Fukai, D., Maeda, Y., Ohnishi, M., Mabuchi, N., Kinoshita, M., 1997. Digitalis increases brain natriuretic peptide in patients with severe congestive heart failure.Am. Heart J.,134(5 Pt 1):910–916.

    Article  PubMed  CAS  Google Scholar 

  • Tsutamoto, T., Wada, A., Maeda, K., Mabuchi, N., Hayashi, M., Tsutsui, T., Ohnishi, M., Sawaki, M., Fujii, M., Matsumoto, T.,et al., 2001. Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure.J. Am. Coll. Cardiol.,37(5):1228–1233.

    Article  PubMed  CAS  Google Scholar 

  • van der Zander, K., Houben, A.J., Kroon, A.A., de Leeuw, P.W., 1999. Effects of brain natriuretic peptide on forearm vasculature: Comparison with atrial natriuretic peptide.Cardiovasc. Res.,44(3):595–600.

    Article  PubMed  Google Scholar 

  • van der Zander, K., Houben, A.J., Kroon, A.A., De Mey, J.G., Smits, P.A., de Leeuw, P.W., 2002. Nitric oxide and potassium channels are involved in brain natriuretic peptide induced vasodilatation in man.J. Hypertens.,20(3):493–499.

    Article  PubMed  Google Scholar 

  • van Veldhuisen, D.J., Genth-Zotz, S., Brouwer, J., Boomsma, F., Netzer, T., Man In'T Veld, A.J., Pinto, Y.M., Lie K.I., Crijns, H.J., 1998. High-versus low-dose ACE inhibition in chronic heart failure: A double-blind, placebo-controlled study of imidapril.J. Am. Coll. Cardiol.,32(7):1811–1818.

    Article  PubMed  Google Scholar 

  • Yoshimura, M., Yasue, H., Okumura, K., Ogawa, H., Jougasaki, M., Mukoyama, M., Nakao, K., Imura, H., 1993. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure.Circulation,87(2):464–469.

    PubMed  CAS  Google Scholar 

  • Zineh, I., Schofield, R.S., Johnson, J.A., 2003. The evolving role of nesiritide in advanced or decompensated heart failure.Pharmacotherapy,23(10):1266–1280.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Clinical Pharmacology and Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, China

    Li Nan & Wang Jian-an

Authors
  1. Li Nan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wang Jian-an
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wang Jian-an.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nan, L., Jian-an, W. Brain natriuretic peptide and optimal management of heart failure. J. Zheijang Univ.-Sci. B 6, 877–884 (2005). https://doi.org/10.1007/BF02840997

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02840997

Key words

Document code

CLC number

Search

Navigation