Drawing Boundaries around PARADISE

Fight-or-flight systems evolved to support humans through acute physiological threats that are now less common than chronic cardiovascular stress. Progressive activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to chronic heart failure, including that which occurs after acute myocardial infarction. Pharmacologic inhibition of the RAAS improves cardiac structure, function, and outcomes. In addition, the natriuretic peptide system is now recognized to provide counterbalance to the RAAS, enhancing natriuresis and vasodilation while decreasing fibrosis and apoptosis. Neprilysin, a zinc-dependent neutral endopeptidase, degrades more than 20 peptides, including natriuretic peptides, angiotensin II, endothelin-1, and bradykinin, and is inhibited . . .

Automated summary

The evolution of the fight-or-flight response system is to help humans deal with acute physiological threats, which are now less common than chronic cardiovascular stress. The study shows that pharmacologic inhibition of RAAS improves chronic heart failure and the natriuretic peptide system provides a counterbalance to RAAS. Neprilysin, a key neutral endopeptidase, degrades a variety of peptides including natriuretic peptides and angiotensin II.