|Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function.|
|PMID: 12559215 Owner: NLM Status: MEDLINE|
|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 Recurrent congestion occurred in 2 of 19 patients withdrawn, and in 1 of 10 patients continuing on furosemide.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.
|Dave J W van Kraaij; René W M M Jansen; Fred C G J Sweep; Willibrord H L Hoefnagels|
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|Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't|
|Title: European journal of heart failure Volume: 5 ISSN: 1388-9842 ISO Abbreviation: Eur. J. Heart Fail. Publication Date: 2003 Jan|
|Created Date: 2003-01-31 Completed Date: 2003-05-30 Revised Date: 2011-06-08|
Medline Journal Info:
|Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: Netherlands|
|Languages: eng Pagination: 47-53 Citation Subset: IM|
|Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
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*
Epinephrine / metabolism
Furosemide / adverse effects*
Heart Failure / complications, drug therapy*, physiopathology*
Heart Rate / drug effects, physiology
Neurotransmitter Agents / metabolism*
Norepinephrine / metabolism
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
Ventricular Function, Left / drug effects*, physiology*
|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 220.127.116.11/Renin|
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