Bioactivity and Interactions of Adrenomedullin and Brain Natriuretic Peptide in Patients With Heart Failure

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Abstract
—Plasma concentrations of the recently discovered hormones adrenomedullin (ADM), from vascular tissue, and brain natriuretic peptide (BNP), secreted by myocardium, are elevated in patients with heart failure. We tested the hypotheses that short-term increments in circulating levels of these hormones, within the pathophysiological range, would have biological effects and that the 2 hormone systems interact. Eight patients with heart failure (left ventricular ejection fractions −1 · min −1 ) alone, ADM (2.7 pmol · kg −1 · min −1 and 5.4 pmol · kg −1 · min −1 for 2 hours each) alone, ADM and BNP combined, and placebo. BNP and ADM infusions raised plasma levels of the respective peptide within the pathophysiological range. Arterial blood pressure fell ( P P P 2-fold increase in plasma renin with both ADM and combined infusions ( P P P P <0.05). The vascular hormones ADM and BNP, produced by myocardium, at plasma concentrations within the pathophysiological range have hemodynamic, renal, and hormonal effects and measurable interactions in patients with heart failure.

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