Differential effects of nifedipine on plasma atrial natriuretic peptide in normal subjects and hypertensive patients

The effects of medications on circulating levels of cardiac natriuretic peptides

Circulating cardiac natriuretic peptide levels are being used increasingly in a range of clinical circumstances. Since it is evident that drugs used in the treatment of cardiovascular disorders can modulate natriuretic peptide levels, we here review the literature documenting these effects. Diuretics, blockers of the renin-angiotensin system, vasodilator agents, dopamine-like agonists, amiodarone, and perhaps allopurinol and statins suppress natriuretic peptide levels, most obviously in heart failure. Beta-blockers stimulate natriuretic peptide concentrations in hypertensive subjects, whereas in heart failure they have little effect or are stimulatory in the short term and inhibitory with sustained therapy. Digitalis compounds and aspirin tend to increase natriuretic peptide levels, and calcium channel blocking agents have varying effects depending on the individual drug and duration of administration. The effects of other drugs are less clear. Additional information is needed regarding the effects of medications along with dissection of the role of altered cardiac secretion versus changes in plasma clearance as explanation for drug-induced perturbations in natriuretic peptide concentrations. In the meantime, clinicians need to consider the known effects of medications when interpreting plasma levels of the cardiac natriuretic peptides.

Atrial natriuretic peptide contributes to the antihypertensive action of many drugs

Data derived from a 10 years research program of our team demonstrate that many categories of antihypertensive drugs like beta-adrenergic blockers, alpha1-adrenergic blockers, ACE inhibitors, AT1-receptor antagonists and calcium-entry blockers increase plasma atrial natriuretic peptide (ANP) levels after a medium-term treatment of patients suffering from moderate essential hypertension. ANP always increases despite the drop of the arterial pressure and the fact that the left atrial and ventricular diameters remain unchanged or slightly reduced. These findings indicate that the increase of ANP plasma levels is not the result of a mechanical overload in the left cardiac chambers but the result of a pharmacological action. In conclusion, ANP is a universal factor contributing to the antihypertensive action of many drugs.

Plasma atrial natriuretic peptide levels in essential hypertension after treatment with verapamil

The aim of this study was to evaluate the long term effects of the selective Ca2+-blocker verapamil on atrial natriuretic peptide (ANP) levels in patients with moderate essential hypertension. The drug was given orally in a daily dose of 300 mg for 30 days. At the end of this clinical trial, plasma ANP levels increased by 16.14% despite the drop in blood pressure while left atrial and ventricular diameters remained unchanged. These findings indicate that the increase of ANP plasma levels is not the result of a mechanical load on the left cardiac chambers but the result of a pharmacological action. These observations also indicate that verapamil exerts part of its antihypertensive action by increasing ANP plasma levels.