Review Question - QID 100556

The human analog of nesiritide is brain natriuretic peptide (BNP) and is produced by the ventricles under increased wall stretch.

BNP and the closely associated atrial natriuretic peptide (ANP) are relevant clinically as they may both be increased in states of heart failure. Both ANP and BNP activate guanylate cyclase and cause vasodilation and diuresis, thus aiding the heart failure state. Neseritide was approved for the treatment of acute decompensated congestive heart failure but a study 2011 (O'Conner, NEJM 2011) showed that the it was not associated with a change in mortality or re-hospitalizations.

King et al. discuss the diagnosis of heart failure. They report that BNP may be used as evidence to "rule-out" systolic heart failure if the serum value is normal. Echocardiography remains the diagnostic standard to confirm systolic or diastolic heart failure by measuring the left ventricular ejection fraction.

Januzzi and Throughton present evidence in support of using BNP as a factor to trend heart failure management, not as a spot value that should be used in isolation. They argue that quantitative biomarkers (such as BNP) have a strong place in managing patients with CHF.

Illustration A shows the relationship between ANP/BNP and other blood pressure regulators.

Incorrect Answers:
Answer 1: Increased external stress results in catecholamine production, not ANP/BNP.
Answer 3: Increased intracranial pressure does not have a direct relationship to hormone responses.
Answer 4: Increased circulatory volume presenting to the kidneys results in decreased renin production.
Answer 5: Decreased circulatory volume presenting to the kidneys results in increased renin production, not ANP/BNP.