Document Detail

Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function.
MedLine Citation:
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 Recurrent congestion occurred in 2 of 19 patients withdrawn, and in 1 of 10 patients continuing on furosemide.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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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of heart failure     Volume:  5     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2003 Jan 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  47-53     Citation Subset:  IM    
Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands.
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MeSH Terms
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
Epinephrine / metabolism
Follow-Up Studies
Furosemide / adverse effects*
Heart Failure / complications,  drug therapy*,  physiopathology*
Heart Rate / drug effects,  physiology
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*
Reg. No./Substance:
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

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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