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1 Department of Internal Medicine, University Hospital Maastricht, Maasrtricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
2 Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
* To whom correspondence should be addressed. E-mail: p.deleeuw{at}intmed.unimaas.nl.
Objective: Brain natriuretic peptide (BNP) is a cardiac hormone with natriuretic activity. The aim of the present study was to investigate the cardiovascular effects of pathophysiological levels of BNP on central hemodynamics, cardiac function, renal hemodynamics and function, and microvascular hemodynamics in healthy subjects. Methods: In this double blind, placebo-controlled, cross-over study we infused BNP (4 pmol/kg/min) or placebo (i.v.) for 1 hour, on two separate days, in 12 healthy subjects (mean age 60±5yr.). Nailfold and conjunctival capillary density, finger skin (thermoregulatory) microvascular blood flow (SBF), and cardiac output, were studied before and after infusion, using intravital videomicroscopy, laser-Doppler fluximetry, and echocardiography respectively. Furthermore, during infusion we measured effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) using PAH/inulin clearance. Blood pressure and heart rate (HR) were monitored at all measurements. Results: Compared to placebo, BNP significantly decreased stroke volume with a tendency to decrease cardiac output. In sitting position, MAP decreased and HR increased after BNP infusion, while in supine position these variables remained unchanged. BNP increased natriuresis, diuresis, GFR, filtration fraction, and filtered load of sodium compared to placebo, while ERPF did not change. BNP did not affect the microvascular capillary density of conjunctiva and skin, SBF, total skin oxygen capacity and post-occlusive recruitment. Conclusion: The present results suggest that BNP has predominantly central and renal hemodynamic effects, while it does not influence peripheral microcirculation in skin and conjunctiva.
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