Cardiac natriuretic peptides (BNP and ANP), discovered as hormones from the heart's endocrine system, have become essential biomarkers for heart failure diagnosis and targets for cardiovascular drug development over four decades of research.
40+ years of translationFour decades of research transformed cardiac natriuretic peptides from a laboratory curiosity into essential clinical biomarkers and drug targets used worldwide
What the researchers found
Cardiac natriuretic peptides (ANP, BNP) serve dual clinical roles: as diagnostic biomarkers for heart failure (BNP and NT-proBNP blood tests are standard of care) and as therapeutic targets (sacubitril/valsartan inhibits neprilysin to increase natriuretic peptide levels). The system encompasses peptide hormones, specific receptors (NPR-A, NPR-B, NPR-C), and processing enzymes.
Why it matters
BNP blood tests are now one of the most commonly ordered cardiac tests worldwide, used daily in emergency rooms and cardiology clinics to diagnose heart failure. Understanding the natriuretic peptide system is essential for anyone working in cardiovascular medicine.
The numbers in context
Four decades of research. BNP and NT-proBNP are the main clinical biomarkers.
How the study worked
Narrative review covering the biochemistry, physiology, and pathophysiology of the cardiac natriuretic peptide system. Discusses molecular components, quantitative methods, and clinical applications in heart failure.
Who was studied
Review of natriuretic peptide research and clinical applications
What this study cannot tell us
Introductory review aimed at non-specialists — may lack depth for experts in the field. Does not cover emerging natriuretic peptide applications (cancer, metabolism) in detail. Focuses primarily on established clinical applications rather than cutting-edge research.
How to read the evidence
Rated strong: comprehensive review from established researchers, covering well-validated clinical applications with decades of supporting evidence.
When this study was published
Published in 2024. Provides a current perspective on a well-established peptide system with ongoing therapeutic development.
The bigger picture
The cardiac natriuretic peptide story illustrates how basic peptide biology can transform clinical practice. What started as a curiosity — the heart producing hormones — led to diagnostic tests used millions of times annually and medications that save lives. This model inspires similar translational approaches for other peptide systems.
Questions still open
- Could natriuretic peptide-guided therapy (adjusting treatment based on BNP levels) improve heart failure outcomes beyond standard care?
- Are there undiscovered clinical applications for natriuretic peptides beyond cardiovascular disease?
- Could synthetic natriuretic peptide analogs with improved properties be developed as next-generation therapeutics?
Common questions
What are natriuretic peptides and why are they important?
What does a BNP blood test tell you?
Read the original research
Cardiac natriuretic peptides.
Advances in clinical chemistry, 122, 115-139
Citation
Shalmi, Theodor W; Jensen, Anne Sophie B; Goetze, Jens P. (2024). Cardiac natriuretic peptides.. Advances in clinical chemistry, 122, 115-139. https://doi.org/10.1016/bs.acc.2024.06.009