Full Text:   <3175>

CLC number: R54

On-line Access: 

Received: 2004-12-17

Revision Accepted: 2005-04-03

Crosschecked: 0000-00-00

Cited: 7

Clicked: 7221

Citations:  Bibtex RefMan EndNote GB/T7714

-   Go to

Article info.
1. Reference List
Open peer comments

Journal of Zhejiang University SCIENCE B 2005 Vol.6 No.9 P.877-884


Brain natriuretic peptide and optimal management of heart failure

Author(s):  LI Nan, WANG Jian-an

Affiliation(s):  Division of Clinical Pharmacology and Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China

Corresponding email(s):   nli_zum@yahoo.com.cn, wang_jian_an@tom.com

Key Words:  Brain natriuretic peptide (BNP), Heart failure, Drug therapy

LI Nan, WANG Jian-an. Brain natriuretic peptide and optimal management of heart failure[J]. Journal of Zhejiang University Science B, 2005, 6(9): 877-884.

@article{title="Brain natriuretic peptide and optimal management of heart failure",
author="LI Nan, WANG Jian-an",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Brain natriuretic peptide and optimal management of heart failure
%A LI Nan
%A WANG Jian-an
%J Journal of Zhejiang University SCIENCE B
%V 6
%N 9
%P 877-884
%@ 1673-1581
%D 2005
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.2005.B0877

T1 - Brain natriuretic peptide and optimal management of heart failure
A1 - LI Nan
A1 - WANG Jian-an
J0 - Journal of Zhejiang University Science B
VL - 6
IS - 9
SP - 877
EP - 884
%@ 1673-1581
Y1 - 2005
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.2005.B0877

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.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1] 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.

[2] 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.

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

[4] 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.

[5] 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.

[6] 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.

[7] de Bold, A.J., 1985. Atrial natriuretic factor: A hormone produced by the heart. Science, 230(4727):767-770.

[8] 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.

[9] 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.

[10] 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.

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

[12] Fujisaki, H., Ito, H., Hirata, Y., Tanaka, M., Hata, M., Lin, M., Adachi, S., Akimoto, H., Marumo, F., Hiroe, 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.

[13] 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.

[14] 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.

[15] 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.

[16] 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.

[17] 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.

[18] 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.

[19] 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.

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

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

[22] 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.

[23] 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.

[24] 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.

[25] 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.

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

[27] 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.

[28] 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.

[29] 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.

[30] 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.

[31] 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.

[32] 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.

[33] 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.

[34] 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.

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

[36] 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.

[37] 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.

[38] 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.

[39] 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.

[40] 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.

[41] 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.

[42] 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.

[43] 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.

[44] 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.

[45] 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.

[46] 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.

[47] 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.

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE