Book Review

Natriuretic Peptides: The Hormones of the Heart

N Engl J Med 2007; 356:2226May 24, 2007

Article

Natriuretic Peptides: The Hormones of the Heart
Edited by Aldo Clerico and Michele Emdin. 184 pp., illustrated. Milan, Springer-Verlag Italia, 2006. $149. ISBN: 978-88-470-0497-9

The 1981 discovery by Adolfo J. de Bold of atrial natriuretic peptide, a peptide hormone secreted by the heart in response to volume expansion, revealed a homeostatic mechanism that counterbalanced the salt- and water-retaining actions of the renin–angiotensin–aldosterone system that predominates in terrestrial animals. This finding was followed by the recognition of additional members of this peptide family in many other tissues, including brain tissue, and the discovery of receptors for these peptides throughout the body. This news beguiled physiologists, physicians, and pharmaceutical companies and led to the expectation that the peptides would be the basis of treatments for diseases in which salt and fluid retention is an aggravating factor — these peptides, it was predicted, would be useful in the treatment of a variety of diseases, including hypertension, acute renal failure, and congestive heart failure. The failure of these peptides to reverse or at least reduce some of these conditions has been disappointing, but not all of the findings have been frustrating. Over the past several years, the measurement of circulating natriuretic peptides has emerged as an important tool in the recognition of, and perhaps also the management of, heart failure.

This book reviews these peptides — their discovery, their involvement in cardiac and cardiovascular physiology, the available clinical tests, their role in cardiovascular and other diseases, and current clinical trials of the peptides in patients with heart disease. The editors and authors have been actively involved in studies of the physiological and clinical role of the peptides in cardiovascular disease, as well as in the development and characterization of the laboratory tests used to measure them in clinical and laboratory settings. This is a useful book for scientists and clinicians alike, summarizing the vast clinical and laboratory experience of its contributors and reviewing most of the available literature on natriuretic peptides.

The book contains seven chapters that can be read independently; each chapter ends with its own summary and conclusions. Several of the topics covered are worth noting. Natriuretic peptides are involved in a multitude of actions throughout the body, serving in endocrine, paracrine, and autocrine functions and possibly as neurotransmitters and immunomodulators. The methods used to measure circulating natriuretic peptides are varied. Some of these methods are restricted to research laboratories, whereas others have found their way into clinical practice. The authors and editors of this book call for standardization of these methods. The value of the measurement of natriuretic peptides as a screening and prognostic tool for heart disease, and as a means to differentiate various types of dyspnea, is appropriately emphasized. The failure of natriuretic peptides, or agents that increase their circulating levels, to reverse salt and water retention in congestive heart failure is very likely due to the tonic effect of counterregulatory systems. The authors postulate that combination therapies that reduce or eliminate these opposing mechanisms could be useful and should be the subject of future research.

Patricio Silva, M.D.
Temple University, Philadelphia, PA 19140