Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function

Autor:	van Kraaij, Dave J.W., Jansen, René W.M.M., Sweep, Fred C.G.J., Hoefnagels, Willibrord H.L., Jansen, René W M M
Předmět:	HEART failure patients ENDOTHELINS DISEASES MORTALITY ACE inhibitors DRUG metabolism ADRENALINE ALDOSTERONE ATRIAL natriuretic peptides BLOOD pressure BODY weight COMPARATIVE studies DIURETICS DRUG withdrawal symptoms ECHOCARDIOGRAPHY FUROSEMIDE CARDIAC contraction LEFT heart ventricle HEART physiology HEART beat HEART failure LONGITUDINAL method RESEARCH methodology MEDICAL cooperation NEUROTRANSMITTERS NORADRENALINE PATIENT compliance RENIN RESEARCH STATISTICS TIME RENIN-angiotensin system EVALUATION research RANDOMIZED controlled trials TREATMENT effectiveness BLIND experiment STROKE volume (Cardiac output) DISEASE complications
Zdroj:	European Journal of Heart Failure; Jan2003, Vol. 5 Issue 1, p47-53, 7p
Abstrakt:	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 Recurrent congestion occurred in 2 of 19 patients withdrawn, and in 1 of 10 patients continuing on furosemide.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 (rs=0.61, P=0.020) and diastolic blood pressure (rs=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. [Copyright &y& Elsevier]
Databáze:	Complementary Index
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