NPPA and cardiac hypertrophy: Cyclic guanosine monophosphate (cGMP), as a second messenger, negatively regulates the secretion of ANP (Lee et al., 2000), and the cGMP-mediated Akt/GSK-3β signaling pathway has been shown to be closely related to cardiac electrophysiology, myocardial hypertrophy, and myocardial contraction (Bork et al., 2019).