The natriuretic peptide system is activated in a broad spectrum of CVDs, including systolic and diastolic LV dysfunction, acute coronary syndromes, stable coronary heart disease, valvular heart disease, acute and chronic right ventricular failure, and left and right ventricular hypertrophy secondary to arterial or pulmonary hypertension (Table 8). These conditions are, to a varying extent, characterized by neurohormonal and immune activation. The activation of vasoconstrictor, antidiuretic, proinflammatory, hypertrophic, and cytoproliferative systems, including the sympathetic nervous system (SNS), renin-angio-tensin-aldosterone system, arginine vasopressin, and ET, is believed to play a pathophysi-ological role in the progression of many of these conditions (151). A prime example is the progressive LV hypertrophy, remodeling, and dilatation that occur in parallel with the clinical progression from asymptomatic LV dysfunction to overt congestive heart failure (CHF), a process that is significantly retarded by neurohormonal blockade. Counteracting the vasoconstrictor neurohormonal systems, the natriuretic peptides possess beneficial and compensatory properties that are of clinical importance. The pathophysiological role that the natriuretic peptides play is probably best defined in CHF.
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