Fig. 3
From: Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management
Heart-kidney interaction is mediated by the natriuretic peptide system counterbalanced by the RAAS and the SNS. In early heart failure, the natriuretic peptide action dominates, leading to suppression of the SNS manifested as vasorelaxation and to natriuresis and diuresis in the kidney, which all translate into a lowered blood pressure. In chronic heart failure, the effectiveness of natriuretic peptides is lost, and actions of the overactivated RAAS and SNS dominate leading to vasoconstriction and expression of renin and angiotensin, which both mediate an increased blood pressure