Agonist antibody to guanylate cyclase receptor NPR1 regulates vascular tone

Antihypertensive drug treatment: are we ready for the future?

Treatment of hypertension generally requires multiple antihypertensive drugs. Yet, not all patients are treated adequately, largely because of nonadherence, although drug ineffectiveness and counterbalancing mechanisms may also play a role. Novel antihypertensive drugs have not been introduced for at least one to two decades. Remarkably, over the last few years, a range of novel compounds is being introduced, acting either on novel targets, or displaying an exceptionally long half-life. The former may help to improve blood pressure lowering, for instance by interfering with counterbalancing mechanisms, while the latter might help to circumvent nonadherence. This review summarizes the latest developments, focusing on novel drugs acting on the endothelin system, the renin-angiotensin-aldosterone system (RAAS), and atrial natriuretic peptide (ANP).

Soluble guanylate cyclase as a direct target for pharmacologic mitigation of chronic kidney disease

In a preclinical rat study, Lichtenberger et al. show that BAY-60-2770, a drug that activates soluble guanylyl cyclase, often rendered inactive by oxidative stress, mitigates kidney inflammation, injury, and fibrosis, likely by vascular effects after ischemia-reperfusion. Kidney perfusion, overall vascular reactivity, and medullary microvascular diameter are improved by the drug at doses that do not alter blood pressure. Soluble guanylyl cyclase is an attractive and potentially unexploited target to halt progression of chronic kidney disease.

Metabolism of Natriuretic peptides and impact on insulin resistance and fat mass in healthy subjects

BACKGROUND

Natriuretic peptides (NP) have important roles in regulating fat balance and metabolic health. Reduced concentrations of ANP and BNP in plasma are associated with increased insulin resistance in obesity. Whether this is due to increased clearance or reduced bioactivity of immunoreactive NP forms is unclear.

DESIGN AND METHOD

These questions were addressed in a community study of mildly obese subjects at middle age. The ratio of amino-terminal (NT) pro-NP to bioactive C-terminal NP was used as a putative index of the clearance of bioactive forms.

RESULTS

Lower ratios of amino-terminal pro-NP to bioactive C-terminal NP were associated with increased insulin resistance. In linear regression models, NT-proANP and NT-proBNP outperformed ANP and BNP in predicting insulin resistance. Pro-NP glycosylation, which can impair NP and NT-proNP production in obesity, does not account for the diminished impact of ANP or BNP. Plasma concentrations of osteocrin, which competes for the NP clearance receptor (NPR-C) and potentially enhances NP bioactivity, was not associated with NPs, but did positively predict insulin resistance in females.

CONCLUSIONS

We find no evidence that increased clearance/degradation of NPs contributes to insulin resistance. Among the nine NP variants assessed, only NT-proANP and NT-proBNP independently predicted insulin resistance in both sexes. The impact of CNP on fat mass or insulin resistance was minor but significant in females. Lower concentrations of immunoreactive plasma ANP and BNP remains unexplained and requires closer study.

Novel pharmacological approaches to lowering blood pressure and managing hypertension

Hypertension is the leading cause of death globally, primarily due to its strong association with cardiovascular disease. The global prevalence of hypertension has surged over the past three decades, driven by rising rates of diabetes mellitus and obesity. Despite current antihypertensive therapies, only a small proportion of patients with hypertension achieve adequate blood pressure control, necessitating novel therapeutic strategies. In this Review we explore the challenges and emerging opportunities in hypertension management. Aprocitentan, a dual endothelin receptor antagonist, is the first agent from a novel class of antihypertensive drug to be licensed since 2007 and exemplifies innovative treatments on the horizon. Here we also address the complex factors contributing to poor hypertension control, including genetic influences, lifestyle factors, therapeutic inertia and poor patient adherence. We discuss the limitations of existing therapies and highlight promising new pharmacological approaches to hypertension management. Integrating these novel treatments alongside current pharmaceuticals combined with improved diagnostic and management strategies could substantially reduce the global burden of hypertension and associated cardiovascular disease.