Cardiac natriuretic peptides

Nat Rev Cardiol. 2020 Nov;17(11):698-717. doi: 10.1038/s41569-020-0381-0. Epub 2020 May 22.


Investigations into the mixed muscle-secretory phenotype of cardiomyocytes from the atrial appendages of the heart led to the discovery that these cells produce, in a regulated manner, two polypeptide hormones - the natriuretic peptides - referred to as atrial natriuretic factor or atrial natriuretic peptide (ANP) and brain or B-type natriuretic peptide (BNP), thereby demonstrating an endocrine function for the heart. Studies on the gene encoding ANP (NPPA) initiated the field of modern research into gene regulation in the cardiovascular system. Additionally, ANP and BNP were found to be the natural ligands for cell membrane-bound guanylyl cyclase receptors that mediate the effects of natriuretic peptides through the generation of intracellular cGMP, which interacts with specific enzymes and ion channels. Natriuretic peptides have many physiological actions and participate in numerous pathophysiological processes. Important clinical entities associated with natriuretic peptide research include heart failure, obesity and systemic hypertension. Plasma levels of natriuretic peptides have proven to be powerful diagnostic and prognostic biomarkers of heart disease. Development of pharmacological agents that are based on natriuretic peptides is an area of active research, with vast potential benefits for the treatment of cardiovascular disease.

Publication types

  • Review

MeSH terms

  • Animals
  • Atrial Appendage / cytology
  • Atrial Fibrillation / metabolism
  • Atrial Natriuretic Factor / genetics
  • Atrial Natriuretic Factor / metabolism*
  • Atrial Natriuretic Factor / physiology
  • Atrial Remodeling
  • Biomarkers / metabolism
  • Cyclic GMP / metabolism
  • Diabetes Mellitus / metabolism
  • Fibrosis
  • Gene Expression Regulation, Developmental
  • Heart Atria / cytology
  • Heart Failure / metabolism*
  • Humans
  • Hypertension / metabolism
  • Lipid Metabolism / physiology
  • Metabolic Syndrome / metabolism
  • Mice
  • Myocardium / metabolism
  • Myocardium / pathology
  • Myocytes, Cardiac / metabolism*
  • Natriuretic Peptide, Brain / genetics
  • Natriuretic Peptide, Brain / metabolism*
  • Natriuretic Peptide, Brain / physiology
  • Obesity / metabolism
  • Peptide Fragments / metabolism
  • Prognosis
  • Protein Processing, Post-Translational
  • Pulmonary Arterial Hypertension / metabolism
  • Receptors, Guanylate Cyclase-Coupled / metabolism*
  • Secretory Vesicles / metabolism
  • Ventricular Remodeling
  • Water-Electrolyte Balance / physiology


  • Biomarkers
  • Peptide Fragments
  • midregional pro-atrial natriuretic peptide, human
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor
  • Receptors, Guanylate Cyclase-Coupled
  • Cyclic GMP