Introduction
The atrial natriuretic peptide (ANP, Atrial Natriuretic Peptide, also called atriopeptin) is a peptide hormone produced by myocardial cells (myocytes) with endocrine activity, located at the atrial level. These cells contain secretory granules, where they accumulate and from which they release the atrial natriuretic peptide, which carries out a "specialized endocrine action at the cardiovascular level.
In addition to the atrial natriuretic peptide, two other related natriuretic peptides are known: the brain natriuretic peptide B (BNP), synthesized by ventricular myocardial cells and some brain neurons (so called because it was originally isolated from the pig's brain), and the natriuretic peptide C (CNP), which is of endothelial origin.
High natriuretic peptides and hypertension
Since the activity of these hormones is superimposable, we speak in the complex of natriuretic peptides. Their release is high when the muscle cells of the heart are stretched more than normal, a situation linked to the excessive presence of blood (hypervolemia), therefore to hypertensive phenomena (also resulting from the use of vasoconstrictor drugs).To compensate for the hypervolemia, natriuretic peptides - as the name suggests - cause a marked increase in diuresis and natriuresis, increasing the excretion of sodium and water through the kidney; moreover, they release the smooth muscles (vasodilating action) both at the systemic and renal level, where the action is directed above all to the arterioles afferent to the glomerulus, while it does not affect the efferent ones, which even tend to force themselves to increase glomerular filtration. These actions are mediated both by direct and indirect mechanisms, linked to the inhibitory effect on the release and / or on the action of various hormones and mediators, such as angiotensin-II, endothelin, aldosterone and vasopressin. Furthermore, natriuretic peptides act directly on the cardiovascular control center of the bulb to reduce arterial pressure, with inhibitory activity on the activation of the sympathetic system. Together, therefore, the natriuretic peptides help to reduce the venous return to the heart and with it the blood pressure values.
Other causes of high natriuretic peptides
Plasma levels of natriuretic peptides increase in physiological conditions (diet rich in sodium, administration of saline solution, supine position, lifting of the legs, immersion in water up to the neck) and in pathological conditions (congestive heart failure, chronic renal failure); instead, they decrease in the opposite conditions (assuming an upright position, low-sodium diet, taking diuretics, dehydration).
Brain natriuretic peptide BNP
Released from the ventricular myocardium in response to the increased stress relieving the walls of the ventricles, typical of hypervolemia and pressure overload, the cerebral natriuretic peptide is an important marker and prognostic indicator of congestive heart failure. According to various studies, blood BNP levels predict cardiac mortality and the risk of numerous adverse cardiac events (heart disease), such as left ventricular hypertrophy, ventricular failure, acute coronary syndrome, acute myocardial infarction and sudden death from cardiac arthritis The plasma BNP assay is also useful for the therapeutic monitoring of patients suffering from congestive heart failure and other heart diseases.
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