Low-dose brain natriuretic peptide infusion in normal men and the influence of endopeptidase inhibition

1. To assess the threshold dose for bioactivity of brain natriuretic peptide and the role of endopeptidase 24.11 in metabolism of brain natriuretic peptide at physiological plasma levels, we studied eight normal men receiving 2 h infusions of low-dose brain natriuretic peptide [0.25 and 0.5 pmol min(-1) kg(-1) with and without pretreatment with an endopeptidase inhibitor (SCH 32615, 250 mg intravenously)] in placebo-controlled studies. 2. Plasma brain natriuretic peptide increased 2-fold during the infusion of 0.25 pmol min(-1) kg(-1) (mean increment above control 3.9 pmol/l, P < 0.001), and tripled (P < 0.001) with 0.5 pmol min(-1) kg(-1). Plasma renin activity was inhibited by both doses (14.8%, P < 0.01, and 20%, P < 0.001, respectively), A significant natriuresis (56% increase in urine sodium/creatinine ratio, P < 0.02) occurred with the higher dose, Blood pressure, haematocrit, plasma cGMP, atrial natriuretic peptide and aldosterone were unaffected by either dose. 3. Compared with brain natriuretic peptide (0.5 pmol min(-1) kg(-1)) alone, SCH 32615 pretreatment increased peak plasma brain natriuretic peptide (13.4 +/- 0.78 versus 12.4 +/- 0.86 pmol/l, P < 0.05), ANP (7.5 +/- 0.96 versus 5.9 +/- 0.4 pmol/l, P < 0.01) and cGMP (4.8 +/- 1.7 versus 3.9 +/- 1.4 nmol/l, P < 0.001). Plasma renin activity was further suppressed with SCH 32615 pretreatment (29% compared with 20%, P < 0.001). 4. Small acute increments in plasma brain natriuretic peptide (4 pmol/l) have significant biological effects in normal men without altering plasma atrial natriuretic peptide or cGMP.