Natriuretic peptides are a family of hormones that regulate sodium balance, blood volume and vascular tone, named for their capacity to promote natriuresis, the renal excretion of sodium. The principal members are atrial natriuretic peptide and B-type natriuretic peptide, released chiefly by cardiac atrial and ventr…
Natriuretic peptides are a family of hormones that regulate sodium balance, blood volume and vascular tone, named for their capacity to promote natriuresis, the renal excretion of sodium. The principal members are atrial natriuretic peptide and B-type natriuretic peptide, released chiefly by cardiac atrial and ventricular myocytes in response to wall stretch and pressure overload, alongside C-type natriuretic peptide of endothelial origin. Acting through guanylyl cyclase-linked receptors and the second messenger cyclic GMP, they induce vasodilation, increase glomerular filtration and sodium excretion, suppress the renin-angiotensin-aldosterone system, and oppose fluid retention, counterbalancing pressor and volume-conserving pathways. Because secretion rises with myocardial stress, B-type natriuretic peptide and its amino-terminal fragment, NT-proBNP, are widely used as biomarkers for diagnosing and gauging the severity of heart failure, for risk stratification, and for prognostication; elevated perioperative concentrations, for example, predict cardiac morbidity and mortality after major surgery. Natriuretic peptide signalling is central to cardiorenal physiology, integrating cardiac, renal and vascular function, and its dysregulation features in heart failure and volume-overload states relevant to dialysis and pulmonary embolism. The pathway is also a therapeutic target, exploited by agents that augment natriuretic peptide activity. Measurement and modulation of these peptides therefore inform cardiovascular and renal diagnosis, prognosis and treatment.
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