Abstract
Activation of many neurohumoral systems occurs in heart failure, resulting in vasoconstriction, retention of natrium ions, and tissue proliferation, all of which worsen the heart failure and thus close the vicious circle. Inhibition of such neurohumoral systems, especially of renin angiotensin aldosterone system and sympatoadrenal system, became the cornerstone of pharmacotherapy of chronic heart failure with reduced ejection fraction.
However, contraregulatory neurohumoral systems are also activated, leading to vasodilatation, natriuresis, and antiproliferative effects. System of natriuretic peptides is the crucial one of these.
Neurohumoral inhibitors were developed, blocking renin angiotensin aldosteron system on one side and inhibiting neutral endopeptidase neprilysin, which cleaves natriuretic peptides and thus potentiates their effects, on the other side.