Wednesday, September 1, 2010

Natriuretic peptides - Physiology & Variations

 Studies conducted in the 1950s, revealed that dilatation of the cardiac atria could induce natriuresis. In 1964, electron microscopy revealed the presence of secretory granules in the atrial myocyte.In 1981 de Bold and colleagues demonstrated that extracts from atrial myocytes injected into rats led to brisk natriuresis and diuresis. These atrial hormones were subsequently named atrial natriuretic peptides(ANP)
The Brain natriuretic peptide (BNP) was discovered from porcine brain in 1988. BNP is first synthesized as prepro-BNP, which is then cleaved to pro-BNP(108 aa) and finally to BNP (32 aa). The remaining 76 aa N terminal unit is called the NT-pro BNP. Both BNP and NT-pro BNP are sensitive diagnostic markers for heart failure.

atrial natriuretic peptide (ANP) regulation of blood pressure


Eventhough both of them can be used for diagnosing heart failure, they have different ranges, cut off values and certain physiological differences.  
BNP is a biologically active neurohormone whereas NT-pro BNP circulates as a inert substance.The clearance mechanisms and half-lives of BNP and NT-proBNP are also different. BNP is degraded by endopeptidases and has a half-life of 5–10 min, whereas NT-proBNP is cleared passively primarily by the kidney and has a half-life of 25–120 min.Despite these notable differences, the two hormones share many similarities in terms of their utility for diagnosis and risk stratification.


Variations in levelsNatriuretic peptide levels have been shown to fluctuate on a day-to-day basis and are correlated with a variety of characteristics. In a study including 911 healthy subjects(with normal LVEF) from the Framingham Heart study cohort, the strongest predictor of a high BNP/NT-pro BNP were older age and female sex. Other predictors for high peptide levels were lower diastolic blood pressure, lower BMI, and a large left atrial size.

As we all know, obesity is associated with higher incidence of Hypertension.The mechanism is likely due to sodium/water retention. If this is true then they might have an inherent low BNP level( also called natriuretic handicap). This was shown nicely...again in a group of Framingham patients that healthy! people who are obese have a low BNP/NT pro BNP. Also patients with Diabetes have a low peptide level. Obesity and Diabetes together have an additive effect on lowering BNP levels.


when intrepreting peptide levels, we should have these physiological variations in mind before making decisions based on BNP/NT-pro BNP levels.

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  74. Super Kamagra 160 mg is a medication that contains a combination of two active ingredients: sildenafil citrate (the active ingredient in Viagra) and dapoxetine (a selective serotonin reuptake inhibitor). The medication is used for the treatment of erectile dysfunction (ED) and premature ejaculation (PE) in men. The sildenafil citrate of Super Kamagra 160 mg works by increasing blood flow to the genital organ of the male during sensual stimulation, which helps to achieve and maintain an erection. The dapoxetine component works by delaying the ejaculation process, allowing for a longer-lasting sensual experience. This is taken orally, typically 30 minutes to 1 hour before sensual activity. The recommended starting dose is one tablet, but the dosage may be adjusted based on individual response and tolerability. It is not recommended to take more than one tablet in 24 hours. Common side effects of this medication include headache, dizziness, nausea, and diarrhea. More serious side effects can include changes in vision or hearing, chest pain, or an erection that lasts longer than 4 hours (which requires immediate medical attention). It is important to consult with a doctor before taking this medicine especially if you have any underlying health conditions or are taking any other medications. It is not recommended for people with severe heart, liver, or kidney problems. Also, it should not be taken with alcohol and grapefruit juice, it can lead to increased side effects.

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  75. Tadagra 20 mg is a medication that is used to treat male sensual function problems (erectile dysfunction or ED). ED is defined as the inability to get or keep an erection firm enough for sensual intercourse. This contains the active ingredient Tadalafil, which belongs to a group of medicines known as phosphodiesterase type 5 (PDE5) inhibitors. This works by increasing blood flow to the genital organ of the male, during sensual stimulation, thereby helping to achieve and maintain an erection. You can buy tadagra 20 mg tablets online. It does this by relaxing the blood vessels in the genital organ which allows for increased blood flow. The medication should not be taken more than once in a 24 hour period and should be taken approximately 30 minutes before sensual activity. It is important to note that this will only work when there is sensual stimulation. It is not an aphrodisiac and will not increase sensual desire. The medication should not be taken by individuals who do not have ED. It is also important to consult a healthcare professional before taking this, especially if you have any pre-existing medical conditions such as heart problems, low blood pressure, or a history of stroke. This medication may cause side effects such as headache, flushing, upset stomach, and back pain. In conclusion, Tadagra 20 mg is an effective treatment for ED, but it is important to follow the instructions provided by your healthcare professional and to use the medication responsibly.

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  76. Tadact 20mg is a medication used to treat erectile dysfunction (ED) in men.It contains the active ingredient Tadalafil, which is a phosphodiesterase type 5 (PDE5) inhibitor.Tadalafil works by relaxing the blood vessels in the genital organ of the male, allowing for increased blood flow and ultimately leading to an erection.The recommended dose of this medicine is one tablet taken orally, approximately 30 minutes before sensual activity.The effects of this can last for up to 36 hours, which is longer than other ED medications on the market. However, it is important to note that sensual stimulation is still necessary in order to achieve an erection.

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  78. Vidalista Professional 20 mg is a medicine used for treating ED. Impotence is a dysfunction where a man is unable to achieve and sustain an erection even though he is sexually aroused. It treats Erectile Dysfunction by relaxing the muscles. The relaxation of muscles further helps in easy blood flow through the blood vessels in the male sex organ. Vidalista Professional controls the enzymes in the penis to maintain an erection after the penis is stocked by relaxing the muscles and increasing blood flow to the penis.

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  81. Tadagra 20mg Tablet is used to treat erectile dysfunction in men. It increases blood flow to the penis to help men get an erection. It works by helping to relax the blood vessels in your penis, allowing blood to flow into your penis when you get sexually excited. Tadagra 20mg Tablet may be taken on an empty stomach or with a meal. It should be strictly taken as advised by your doctor. The medicine will only help you to get an erection if you are sexually stimulated. You should take it about one hour before you plan to have sex. Tadagra 20mg Tablet may be taken on an empty stomach or with a meal. It should be strictly taken as advised by your doctor. The medicine will only help you to get an erection if you are sexually stimulated.

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  82. Tadact 20 mg is your ultimate solution for a fulfilling and satisfying intimate experience. Tadact 20 mg is a powerful and reliable medication designed to treat erectile dysfunction (ED) in men. With its exceptional efficacy, Tadact 20 mg has gained immense popularity among individuals seeking a renewed sense of confidence and intimacy in their lives. What sets Tadact 20 mg apart is its active ingredient, Tadalafil, which belongs to a class of medications known as PDE5 inhibitors. This potent compound works by relaxing the blood vessels in the genital area, allowing for increased blood flow and promoting stronger and longer-lasting erections. You can buy Tadact 20 mg tablets online. By enhancing the natural response to sensual stimulation, Tadact 20 mg enables men to regain control over their sensual performance and enjoy a more satisfying experience. Tadact 20 mg offers a reliable solution that can last for up to 36 hours, providing flexibility and spontaneity in intimate moments. This extended duration ensures that you can embrace the joy of intimacy without the pressure of time constraints. Whether you have planned encounters or spontaneous moments of passion, Tadact 20 mg is your trusted ally in achieving and maintaining strong erections.

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  84. Sildigra 100 mg is a prescription based product which contains sildenafil citrate(100 mg) and is used for the treatment of Erectile dysfunction or impotence in men.The salt present in this medicine is fda approved and belongs to the class ofPDE5 inhibitors group which helps to increase the blood flow in the body and helps them to attain a firm Erection better for intercourse.This provides you asatisfactory intercourse which leads to a more happier life for you and makes easy for you to have a normal life.


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  86. Vidalista professional 20mg Tablet is utilized to treat erectile brokenness in men. It increments blood stream to the penis to assist men with getting an erection. It works by assisting with loosening up the veins in your penis, permitting blood to stream into your penis when you get physically energized. These tablets are safe to use and effectively cure impotence and diseases associated with PDE5 inhibitors. These oral drugs are effectively used in the treatment for ED disorders in men assuring erection for longer duration of time.

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  87. "https://www.globelmeds.com/tadagra-20mg.html">Tadagra 20mg Tablet is used to treat erectile dysfunction in men. Tadagra contains tadalafil as its active ingredient. This medicine acts by increasing the blood flow to the male genital organ.It is a PDE5 inhibitor.

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  88. Super p force 160 mg is a combination of two powerful salts which are termed as sildenafil(100 mg) and dapoxetine (60 mg).This medicine cures two problems at one time.Sildenafil is used to treat erectile dysfunction in men and dapoxetine is used to treat premature ejaculation in men.

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