PMID- 16087141
OWN - NLM
STAT- MEDLINE
DCOM- 20051213
LR  - 20110608
IS  - 1388-9842 (Print)
IS  - 1388-9842 (Linking)
VI  - 7
IP  - 5
DP  - 2005 Aug
TI  - Clinical and neurohumoral consequences of diuretic withdrawal in patients with 
      chronic, stabilized heart failure and systolic dysfunction.
PG  - 892-8
AB  - BACKGROUND: Loop diuretics are beneficial in heart failure in the short term 
      because they eliminate fluid retention, but in the long-term, they could 
      adversely influence prognosis due to activation of neurohumoral mechanisms. AIMS: 
      To explore the changes induced by diuretic withdrawal in chronic nonadvanced 
      heart failure. METHODS: Diuretics were withdrawn in 26 stabilized heart failure 
      patients with systolic dysfunction (ejection fraction [EF]<45%). Clinical status 
      was evaluated by physical exam, exercise capacity (corridor test) and New York 
      Heart Association (NYHA) class. Biochemical and neurohumoral determinations were 
      performed at baseline and at 3 months. RESULTS: At 3 months, 17 out of 26 
      patients (65%) were able to tolerate diuretic interruption without a 
      deterioration in exercise capacity or New York Heart Association functional 
      class. Renal function parameters improved (baseline urea 46.2+/-10.8 to 
      39.2+/-10.1 mg/dl at 3 months, p=0.014; creatinine 1.1+/-0.23 to 0.98+/-0.2 
      mg/dl, p=0.013). Glucose metabolism also improved (fasting glucose 151+/-91 to 
      122+/-14 mg/dl, p=0.035). Heart rate and systolic blood pressure did not 
      significantly change, while diastolic blood pressure increased (from 80+/-10 to 
      87+/-13 mm Hg, p=0.006). Neurohumoral determinations showed a decrease in plasma 
      renin activity (4.19+/-5.96 to 2.88+/-4.98 ng/ml, p=0.026), with no changes in 
      aldosterone, arginine-vasopressin, endothelin-1 and norepinephrine. In contrast, 
      atrial natriuretic peptide significantly increased (115+/-87 to 168+/-155 pg/ml, 
      p=0.004). CONCLUSION: Diuretic withdrawal in stabilized heart failure with 
      systolic dysfunction is associated with an improvement in renal function 
      parameters, glucose metabolism and some neurohumoral parameters, such as plasma 
      renin activity; however, atrial natriuretic peptide levels increased.
FAU - Galve, Enrique
AU  - Galve E
AD  - Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Pg Vall 
      d'Hebron 119-129, 08035 Barcelona, Spain. egalve@vhebron.net
FAU - Mallol, Anna
AU  - Mallol A
FAU - Catalan, Robert
AU  - Catalan R
FAU - Palet, Jordi
AU  - Palet J
FAU - Mendez, Stella
AU  - Mendez S
FAU - Nieto, Elsa
AU  - Nieto E
FAU - Diaz, Anna
AU  - Diaz A
FAU - Soler-Soler, Jordi
AU  - Soler-Soler J
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
RN  - 0 (Diuretics)
RN  - 0 (Sodium Potassium Chloride Symporter Inhibitors)
RN  - 85637-73-6 (Atrial Natriuretic Factor)
RN  - EC 3.4.23.15 (Renin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Natriuretic Factor/blood
MH  - Diuretics/*pharmacology/therapeutic use
MH  - Female
MH  - Heart Failure/blood/*drug therapy/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Renin/blood
MH  - Sodium Potassium Chloride Symporter Inhibitors/*pharmacology/therapeutic use
MH  - Substance Withdrawal Syndrome
EDAT- 2005/08/10 09:00
MHDA- 2005/12/15 09:00
CRDT- 2005/08/10 09:00
PHST- 2004/04/19 00:00 [received]
PHST- 2004/09/14 00:00 [revised]
PHST- 2004/09/20 00:00 [accepted]
PHST- 2005/08/10 09:00 [pubmed]
PHST- 2005/12/15 09:00 [medline]
PHST- 2005/08/10 09:00 [entrez]
AID - S1388-9842(04)00244-2 [pii]
AID - 10.1016/j.ejheart.2004.09.006 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2005 Aug;7(5):892-8. doi: 10.1016/j.ejheart.2004.09.006.