Novel therapeutic directions for the natriuretic peptides in cardiovascular diseases: what's on the horizon.

Remarkable advances have occurred since the discovery of ANP. The field of the natriuretic peptides has moved beyond their role as regulators of renal function. Growing evidence has now established the natriuretic peptides as regulators of myocardial structure and function as well as in cardiovascular regulation. Further, they emerge as being products not only of the cardiomyocyte but also of the cardiac fibroblast. Studies in vitro and in vivo have clearly established these cardiac hormones as antihypertrophic and antifibrotic. Further, indications such as cardioprotection for acute myocardial infarction, chronic therapy with oral BNP for hypertension and next generation peptides such as DNP-like peptides for acute heart failure may be in the near future. Novel therapeutic strategies to be tested in clinical trials in humans with cardiovascular disease are clearly on the horizon.