| Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function. | |
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MedLine Citation:
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PMID: 12559215 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In heart failure patients, diuretics cause renin-angiotensin-aldosterone system (RAS) activation, which may lead to increased morbidity and mortality despite short-term symptomatic improvement. AIM: To determine changes in RAS activation and clinical correlates following furosemide withdrawal in elderly heart failure patients without left ventricular systolic dysfunction. METHODS AND RESULTS: We performed clinical assessments and laboratory determinations of aldosterone, plasma renin activity (PRA), atrial natriuretic peptide (ANP), norepinephrine, and endothelin in 29 heart failure patients [aged 75.1+/-0.7 (mean+/-S.E.M.) years], before, 1 and 3 months after placebo-controlled furosemide withdrawal. Recurrent congestion occurred in 2 of 19 patients withdrawn, and in 1 of 10 patients continuing on furosemide. Three months after withdrawal, PRA had decreased -1.61+/-0.71 nmol/l/h (P<0.05). Decreases in aldosterone levels did not reach significance (-0.17+/-0.38 nmol/l). The decreases in PRA after withdrawal correlated with decreases in systolic (r(s)=0.61, P=0.020) and diastolic blood pressure (r(s)=0.80, P=0.01). Successful withdrawal was associated with increases in norepinephrine (+0.58+/-0.22 nmol/l) and ANP (+3.5+/-1.3 pmol/l) (P<0.05) after 1 month, but these changes did not persist after 3 months. Endothelin levels did not change in both groups. CONCLUSION: Successful furosemide withdrawal in elderly heart failure patients causes persistent decreases in RAS activation. |
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Authors:
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Dave J W van Kraaij; René W M M Jansen; Fred C G J Sweep; Willibrord H L Hoefnagels |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European journal of heart failure Volume: 5 ISSN: 1388-9842 ISO Abbreviation: Eur. J. Heart Fail. Publication Date: 2003 Jan |
Date Detail:
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Created Date: 2003-01-31 Completed Date: 2003-05-30 Revised Date: 2011-06-08 |
Medline Journal Info:
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Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: Netherlands |
Other Details:
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Languages: eng Pagination: 47-53 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands. dvankraaij@hotmail.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aldosterone / metabolism Angiotensin-Converting Enzyme Inhibitors / therapeutic use Atrial Natriuretic Factor / blood, drug effects Blood Pressure / drug effects, physiology Body Weight / drug effects, physiology Diuretics / adverse effects* Double-Blind Method Echocardiography Epinephrine / metabolism Female Follow-Up Studies Furosemide / adverse effects* Heart Failure / complications, drug therapy*, physiopathology* Heart Rate / drug effects, physiology Humans Male Neurotransmitter Agents / metabolism* Norepinephrine / metabolism Patient Compliance Renin / blood, drug effects Renin-Angiotensin System / drug effects*, physiology* Statistics as Topic Stroke Volume / drug effects, physiology Substance Withdrawal Syndrome / etiology* Systole / drug effects, physiology Time Factors Treatment Outcome Ventricular Function, Left / drug effects*, physiology* |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 0/Neurotransmitter Agents; 51-41-2/Norepinephrine; 51-43-4/Epinephrine; 52-39-1/Aldosterone; 54-31-9/Furosemide; 85637-73-6/Atrial Natriuretic Factor; EC 3.4.23.15/Renin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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