PMID- 8422000
OWN - NLM
STAT- MEDLINE
DCOM- 19930218
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 71
IP  - 3
DP  - 1993 Jan 21
TI  - Spironolactone in congestive heart failure refractory to high-dose loop diuretic 
      and low-dose angiotensin-converting enzyme inhibitor.
PG  - 21A-28A
AB  - Patients with severe congestive heart failure (New York Heart Association [NYHA] 
      functional classes III-IV) often can tolerate only low doses of 
      angiotensin-converting enzyme (ACE) inhibitors because pronounced hypotension 
      caused by additional ACE inhibitor increments may decrease renal perfusion. The 
      use of high-dose loop diuretics is currently advised to overcome diuretic 
      resistance in refractory congestive heart failure (CHF). In a baseline controlled 
      study, we evaluated 21 patients with diuretic resistance and evident fluid 
      retention for the responses to 5 days of double drug therapy consisting of 
      high-dose loop diuretic (10 mg oral bumetanide) in combination with the maximum 
      tolerable dose of an ACE inhibitor (individualized to blood pressure and kidney 
      function). Five patients (24%) showed a gross natriuresis and reduction in excess 
      weight > 25% in response to this therapy. The remaining 16 patients (76%) with 
      insufficient responses (i.e., < 25% reduction in excess weight) subsequently 
      received 100 mg spironolactone once a day for 7 days in addition to the double 
      therapy. Spironolactone coadministration was highly effective in 13 of 16 
      patients (81%). Marked natriuresis and diuresis were achieved within the next 
      week of treatment, and CHF symptoms regressed or disappeared. The clinical course 
      was similar in the bumetanide-ACE inhibitor and the bumetanide-ACE 
      inhibitor-spironolactone treatment (triple therapy) groups. Plasma aldosterone 
      was significantly higher (p < 0.05) in the patients who needed spironolactone. 
      The 3 patients who were considered refractory to triple therapy exhibited the 
      highest baseline plasma aldosterone concentrations.(ABSTRACT TRUNCATED AT 250 
      WORDS)
FAU - van Vliet, A A
AU  - van Vliet AA
AD  - Department of Internal Medicine, Free University Hospital, Amsterdam, The 
      Netherlands.
FAU - Donker, A J
AU  - Donker AJ
FAU - Nauta, J J
AU  - Nauta JJ
FAU - Verheugt, F W
AU  - Verheugt FW
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0Y2S3XUQ5H (Bumetanide)
RN  - 27O7W4T232 (Spironolactone)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin-Converting Enzyme Inhibitors/administration & dosage/*therapeutic use
MH  - Bumetanide/administration & dosage/*therapeutic use
MH  - Drug Resistance
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Renin-Angiotensin System/drug effects
MH  - Spironolactone/*therapeutic use
MH  - Water-Electrolyte Balance/drug effects
EDAT- 1993/01/21 00:00
MHDA- 1993/01/21 00:01
CRDT- 1993/01/21 00:00
PHST- 1993/01/21 00:00 [pubmed]
PHST- 1993/01/21 00:01 [medline]
PHST- 1993/01/21 00:00 [entrez]
AID - 0002-9149(93)90241-4 [pii]
AID - 10.1016/0002-9149(93)90241-4 [doi]
PST - ppublish
SO  - Am J Cardiol. 1993 Jan 21;71(3):21A-28A. doi: 10.1016/0002-9149(93)90241-4.