Natriuretic Peptides as Regulators of Myocardial Structure and Function: Pathophysiologic and Therapeutic Implications

Much progress has occurred since the discovery of ANP. Indeed, the field of natriuretic peptides has moved markedly beyond their role as regulators of renal function. This article has reviewed growing evidence supporting the role of natriuretic peptides as regulators of myocardial structure and function. They are emerging as products not only of the cardiomyocyte but also of the cardiac fibroblast. Studies in vitro and in vivo have clearly established these cardiac hormones as antihypertrophic and antifibrotic. Indications such as cardioprotection for acute myocardial infarction, chronic therapy with oral BNP for hypertension, and next generation DNP-like peptides for acute heart failure may be in the near future. A movement toward such therapeutic strategies in clinical trials in humans with cardiovascular disease is on the horizon.