Neurohormones in Congestive Heart Failure

Abstract

The past 15 yr have witnessed an explosive growth of knowledge regarding neuroendocrine activation in the syndrome of congestive heart failure. It has become clear that activation of the sympathetic nervous system and the renin-angiotensin-aldosterone axis are involved in the pathogenesis of the syndrome. Other neurohormones including arginine vasopressin, neuropeptide Y, endothelin, atrial natriuretic factor, and prostaglandins are also frequently found to have enhanced activity in the syndrome of heart failure and may be important in pathogenesis. In general, neuroendocrine activation also serves as a marker for the severity of the syndrome and in some cases can be used to help predict prognosis. Knowledge of the various neuroendocrine systems and their derangement in heart failure has led to development of new concepts in the treatment of heart failure. Angiotensin-converting enzyme inhibitors have now emerged as the cornerstone of treatment for patients with all classes of congestive heart failure. As more information becomes available at the molecular level, even more innovative forms of treatment may emerge that are targeted toward specific neuroendocrine abnormalities. (Cardiol Rev 1993;1:5, 278-289)