On the other hand, through the activation in the myocardiocytes of growth factor β1 and the Smad proteins, which increase transcription of the genes related to atrial natriuretic peptide and the heavy chain of β-myosin, it is capable of promoting left ventricular hypertrophy and myocardial fibrosis [56]. This evidence concerns the gene NPPA and Myocardial fibrosis.