Atrial Natriuretic Peptide during Mineralocorticoid Escape in the Human*

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Abstract
The relationship between plasma atrial natriuretic peptide (ANP) and mineralocorticoid escape was examined in six normal men (age, 20-32 yr) treated with 0.4 mg/day fludrocortisone acetate for 9-14 days. Urinary sodium excretion decreased from 162 .+-. 15 (SEM) meq/24 h before to 97 .+-. 10 meq/24 h during fludrocortisone acetate administration (P < 0.05). Despite continued fludrocortisone acetate administration, sodium excretion subsequently returned to baseline (escape). Plasma ANP increased from 33 .+-. 6 pg/ml (control) to 55 .+-. 14 pg/ml on the first day of escape (P < 0.05). Escape was associated with a decrease in PRA from 0.90 .+-. 0.22 (control) to 0.26 .+-. 0.08 ng/ml .cntdot. h (escape, P < 0.05). The escape phenomenon was not associated with a significant change in mean arterial pressure or glomerular filtration rate. This study demonstrates that mineralocorticoid escape is temporally related to a significant increase in circulating ANP.