Natriuretic Peptides: The Heart's Natural Blood Pressure Defense and New Drug Targets

ANP and BNP are released by the heart in response to increased pressure or volume. They lower blood pressure and reduce fluid retention through specific receptors. CNP is produced by blood vessel walls and acts locally to protect blood vessels.

Beyond lowering blood pressure, natriuretic peptides also reduce the organ damage caused by hypertension, including heart enlargement, kidney damage, and blood vessel stiffening.

Neprilysin is the enzyme that degrades natriuretic peptides. Blocking neprilysin with drugs increases the activity of the body's own peptides. A dual inhibitor combining neprilysin inhibition with an angiotensin receptor blocker (sacubitril/valsartan) has been approved for heart failure, and clinical data shows neprilysin inhibition also benefits hypertension patients.

High blood pressure is the leading risk factor for heart disease and stroke worldwide. The natriuretic peptide system represents a natural defense mechanism that the body uses to fight elevated blood pressure. Drugs that enhance this system, rather than simply blocking harmful pathways, offer a fundamentally different approach to treatment.

The approval of sacubitril/valsartan for heart failure has already validated this approach, and expanding its use to hypertension could benefit millions of patients.

As a review article, this does not present new experimental data. The coverage of neprilysin inhibition for hypertension is based on limited clinical data compared to the robust heart failure evidence.

The review may not include the most recent clinical trial results published after its writing.