Atrial natriuretic peptide

Summary

Atrial natriuretic peptide (ANP) is an endogenous 28-amino acid peptide hormone secreted primarily by cardiac atria in response to increased wall stretch or volume overload. It promotes sodium and water excretion, reduces blood pressure, and counterbalances the RAAS. Synthetic forms have been investigated clinically (e.g., carperitide in Japan) for acute decompensated heart failure, though ANP itself remains largely a research tool in Western markets.

Mechanism of Action

Binds to natriuretic peptide receptor-A (NPR-A/GC-A), activating guanylyl cyclase and increasing intracellular cGMP, leading to vasodilation, natriuresis, diuresis, inhibition of the renin-angiotensin-aldosterone system (RAAS), and suppression of sympathetic nervous system activity.

Routes of Administration

Goals & Uses

• Pulmonary hypertension managementCardiovascularLow
• Blood pressure reductionCardiovascularModerate
• Natriuresis and diuresisFluid/electrolyte ManagementHigh
• Acute decompensated heart failure treatmentCardiovascularModerate
• Renal protection in acute kidney injuryRenalLow
• RAAS suppressionCardiovascular/EndocrineHigh

Contraindications

• Severe aortic or mitral stenosisCardiovascularModerate
• Constrictive pericarditis / pericardial tamponadeCardiovascularModerate
• Cardiogenic shockCardiovascularHigh
• Hypersensitivity to ANP or carperitideImmunologicalHigh
• HypotensionCardiovascularHigh

Adverse Effects

• Tachycardia (reflex)CardiovascularUncommon
• HeadacheNeurologicUncommonPain in the head or upper neck
• Dizziness / lightheadednessNeurologicCommon
• HypotensionCardiovascularCommonLow blood pressure
• Renal dysfunctionRenalRare
• NauseaGastrointestinalUncommonFeeling of sickness or urge to vomit

Drug Interactions

• Phosphodiesterase inhibitors (e.g., sildenafil)High
• Antihypertensive agentsModerate
• ACE inhibitors / ARBsModerate
• NSAIDsModerateMay increase renal risk in susceptible patients
• DiureticsModerateMay worsen dehydration or electrolyte imbalance

Population Constraints

• PregnancyReproductive SafetyRelative
• Hepatic impairmentOrgan FunctionRelative
• Severe renal impairmentOrgan ImpairmentRelative
• Pediatric patientsAgeRelative
• Elderly patientsAgeRelative

Regulatory Status

• European UnionUnapprovedNo EMA approval for ANP as a therapeutic agent; primarily a research compound.
• United StatesUnapprovedANP is not approved by the FDA as a therapeutic. Used in research. Nesiritide (BNP) is the approved natriuretic peptide for acute decompensated heart failure.
• United KingdomUnapprovedNot approved by MHRA as a therapeutic; research use only.

Carperitide (synthetic human ANP) is approved in Japan for acute heart failure. In the US and EU, native ANP is not approved as a therapeutic agent; it is primarily used in research settings. Nesiritide (BNP) is the approved natriuretic peptide therapy in the US for acute decompensated heart failure.

Evidence & Sources

No sources recorded yet.