Differential Regulation of ANP and BNP in Acute Decompensated Heart Failure: Deficiency of ANP

JACC Heart Fail. 2019 Oct;7(10):891-898. doi: 10.1016/j.jchf.2019.05.012. Epub 2019 Sep 11.


Objectives: This study investigated the differential regulation of circulating atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with acute decompensated heart failure (ADHF) and tested the hypothesis that a relative deficiency of ANP exists in a subgroup of patients with ADHF.

Background: The endocrine heart releases the cardiac hormones ANP and BNP, which play a key role in cardiovascular (CV), renal, and metabolic homeostasis. In heart failure (HF), both plasma ANP and BNP are increased as a compensatory homeostatic response to myocardial overload.

Methods: ANP and BNP concentrations were measured in a small group of patients with ADHF (n = 112). To support this study's goal, a total of 129 healthy subjects were prospectively recruited to establish contemporary normal values for ANP and BNP. Plasma 3',5'cyclic guanosine monophosphate (cGMP), ejection fraction (EF), and body mass index (BMI) were measured in these subjects.

Results: In cases of ADHF, 74% of patients showed elevated ANP and BNP. Importantly, 26% of patients were characterized as having normal ANP (21% of this subgroup had normal ANP and elevated BNP). Cyclic GMP was lowest in the ADHF group with normal levels of ANP (p < 0.001), whereas BMI and EF were inversely related to ANP levels (p = 0.003).

Conclusions: Among a subgroup of patients hospitalized with ADHF, the presence of an ANP deficiency is consistent with a differential regulation of ANP and BNP and suggests the existence of a potentially compromised compensatory cardiac endocrine response. These findings have implications for the pathophysiology, diagnostics, and therapeutics of human HF.

Keywords: acute decompensated heart failure; atrial natriuretic peptide; atrial natriuretic peptide deficiency; natriuretic peptide.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Natriuretic Factor / blood*
  • Atrial Natriuretic Factor / deficiency
  • Body Mass Index
  • Case-Control Studies
  • Cyclic GMP / blood
  • Female
  • Heart Failure / blood*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Phenotype
  • Stroke Volume


  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor
  • Cyclic GMP