Chamber-specific regulation of atrial natriuretic peptide secretion in cardiac hypertrophy: atrial wall dynamics in the ANP secretion

The heart is involved in the regulation of blood pressure and body fluid homeostasis. As a blood volume sensor and effector for the regulation of the volume and pressure homeostasis, the atria are the central regulator to secrete humoral messenger cardiac natriuretic hormones into the circulation. The primary action of the atria in response to the volume change in the body is to control the secretion of atrial natriuretic peptide (ANP), a member of the family of cardiac natriuretic hormones. Although all cardiac chambers are able to secrete ANP, the major source of the cardiac hormone is the atria until reactivation of the synthesis of the ventricles. In heart disease including hypertension and cardiac hypertrophy, ventricular ANP synthesis and plasma levels of ANP are increased. However, the roles of the atria for the ANP secretion are not well defined in hypertension or heart failure. Under the high concentration of plasma levels of ANP by compensatory and/or pathophysiological reactivation of the ventricular synthesis and release of ANP, with activation of the renin-angiotensin system and changes in the atrial distensibility, the roles of the atria should be reevaluated in the heart disease. The purpose of the present review is to address modulation of the atrial role in the regulation of ANP secretion and its significance in the pathological changes in hypertension and cardiac disease and to strengthen the importance of the role of the interstitial fluid dynamics of the atrial wall in the regulation of ANP secretion.