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Delayed hypertension (HT) and renal dysfunction (RD) are observed after aortic operations accompanied by infra-renal aortic cross-clamping (AXC). Atrial natriuretic peptide (ANP) has effects on vasodilation and renal protection, and we examined the hypothesis that synthetic human α-ANP (hANP) improves the postoperative management for abdominal aortic aneurysm (AAA).Fifty patients undergoing elective aneurysmectomy for infrarenal-AAA between 1998 and 2001 (M:F = 43:7, mean age 70.5 ± 7.7 years) were randomly allocated to one of 2 groups; Group H (n = 24) received hANP immediately after operation (initial dose: 0.025 μg/kg/min), and Group C (n = 26) served as a control group.All patients in Group C required nicardipine hydrochloride (4.41 ± 1.68 mg/h) for prevention of postoperative HT, whereas only 6 patients in Group H required the increase in hANP dose due to HT (P < 0.0001). Maximum hANP dose was 0.035 ± 0.019 μg/kg/min. Group H showed significantly smaller furosemide dosage in the initial 3 days (H vs. C; 9.2 ± 11.0 vs. 58.8 ± 41.5 mg, P < 0.0001), significantly lower peak-Crn (H vs. C; 1.16 ± 0.53 vs. 2.58 ± 1.42 mg/dL, P < 0.0001), and significantly lower plasma renin-activity (7.09 ± 2.38 vs. 11.52 ± 4.89 ng/mL/h, P = 0.0002) and aldosterone (51.6 ± 12.7 vs. 81.2 ± 34.2 pg/mL, P = 0.0002) on the first postoperative day than Group C did.These results imply that renin-angiotensin system may play a role in the incidence of postoperative HT and RD, and suggest that hANP infusion is a simple, reliable, and effective method for management during the immediate period after AAA operations.