Table 2.

Mechanisms of reduced effectiveness of the natriuretic peptide system (NPS) in chronic heart failure

Decreased availability of biologically active NPs
Reduced production of NPs
Increased enzymatic degradation of NPs
Increased receptor‐mediated clearance of NPs
Diminished target organ responsiveness to NPs
Reduced NP receptor expression
Desensitization of NP receptors
Inhibition of downstream signalling
Counter‐regulation of the NPS by antagonistic hormonal systems
Over‐activation of the renin‐angiotensin‐aldosterone system
Over‐activation of the sympathetic nervous system
Over‐activation of endothelin‐1

NP, natriuretic peptide.