This review examines how natriuretic peptides — especially ANP, BNP, and CNP — protect the heart, serve as key biomarkers for diagnosing heart failure, and hold promise as therapeutic agents.
BNP/NT-proBNP: standard heart failure biomarkersThese natriuretic peptide measurements have become essential diagnostic tools, reflecting cardiac load and guiding treatment decisions in heart failure patients
What the researchers found
The review consolidates evidence that natriuretic peptides serve a dual role in heart failure — as diagnostic biomarkers and as cardioprotective agents. ANP and BNP directly oppose the effects of angiotensin II through diuretic/natriuretic actions (promoting water and sodium excretion), vasodilation (relaxing blood vessels), and inhibition of aldosterone secretion. CNP primarily regulates vascular tone and blood pressure.
BNP and NT-proBNP (a cleavage product of proBNP processing) are elevated in heart failure patients and have become standard clinical biomarkers for detecting cardiac load. The review discusses how understanding the full biology of these peptides — from gene expression to receptor signaling — is informing development of natriuretic peptide-based therapeutics.
Why it matters
Heart failure affects tens of millions of people worldwide and remains a leading cause of hospitalization and death. Natriuretic peptide blood tests (BNP and NT-proBNP) have transformed how doctors diagnose and monitor heart failure, and understanding the underlying biology is critical for developing next-generation treatments. This review bridges the gap between basic peptide science and clinical cardiology.
The numbers in context
Covers ANP, BNP, NT-proBNP, CNP as biomarkers and therapeutics; antagonistic to angiotensin II/aldosterone
How the study worked
This is a comprehensive narrative review synthesizing basic science research, clinical studies, and translational findings on the natriuretic peptide family. It covers the physiological functions of ANP, BNP, and CNP, their roles in cardiovascular homeostasis, pathophysiological changes in heart failure, and clinical applications as biomarkers and therapeutic agents.
Who was studied
N/A (review of natriuretic peptide research)
What this study cannot tell us
This is a narrative review and does not include new experimental data. It reflects one author's synthesis and interpretation of the literature. As a 2021 publication, it may not capture the most recent clinical trial data on natriuretic peptide-based therapeutics.
How to read the evidence
This is a narrative review article published in Pharmacology & Therapeutics, synthesizing decades of basic and clinical research. It provides an authoritative overview but does not present original data or systematic evidence grading.
When this study was published
Published in 2021, this review captures the state of natriuretic peptide research through 2020–2021, including the era of neprilysin inhibitor therapy (sacubitril/valsartan) and modern biomarker-guided treatment approaches.
The bigger picture
Natriuretic peptides are among the most clinically important peptide families in medicine. Their role extends beyond heart failure — they're implicated in hypertension, kidney disease, and metabolic syndrome. The therapeutic arm of this field includes sacubitril/valsartan (Entresto), which works by inhibiting the breakdown of natriuretic peptides, and ongoing research into direct ANP/BNP-based treatments. This review provides the foundational knowledge for understanding these developments.
Questions still open
- Can direct natriuretic peptide-based therapies improve heart failure outcomes beyond what neprilysin inhibitors like sacubitril already achieve?
- How can natriuretic peptide testing be optimized to distinguish between different types and stages of heart failure?
- Could CNP-targeted therapies address vascular aspects of heart failure that ANP/BNP-based approaches miss?
Common questions
What is a BNP blood test and why do doctors order it?
Are natriuretic peptides used as actual treatments, not just tests?
Read the original research
The natriuretic peptide system in heart failure: Diagnostic and therapeutic implications.
Pharmacology & therapeutics, 227, 107863
Citation
Kuwahara, Koichiro. (2021). The natriuretic peptide system in heart failure: Diagnostic and therapeutic implications.. Pharmacology & therapeutics, 227, 107863. https://doi.org/10.1016/j.pharmthera.2021.107863