After screening, 13 patients were excluded from participation because of a heart failure score of more than 7 (n=5), elevated BP (n=4), chronic atrial fibrillation (n=3), and second-degree atrioventricular block (n=1). One patient had already stopped using furosemide, and 3 patients decided not to participate in the study after screening. A cardiologist subsequently evaluated 38 patients with testing that included echocardiography and a standard upright bicycle stress test. All patients underwent complete M-mode, 2-dimensional, and Doppler echocardiography (128 XP/10c; Acuson Benelux BV, Almere-Haven, the Netherlands) with a 2.0-, 2.5-, and/or 3.5-MHz electronic phased-array transducer. All echocardiograms were interpreted by a single cardiologist (L.H.R.B.), who was blinded to randomization results and meal-related BP measurements. The time course of left ventricular filling can be studied by Doppler echocardiography, producing a number of indices that describe the duration of ventricular relaxation, the peak rate or velocity of filling, and the contribution of atrial contraction on filling volume. The following transmitral Doppler indices of left ventricular diastolic filling were measured in at least 3 consecutive cardiac cycles and averaged: peak velocity of early flow (peak E), peak velocity of late flow (peak A), ratio of early to late flow (E/A ratio), and deceleration time (the time from the peak of the E wave to the beginning of diastasis). Preset exclusion criteria at this stage were a left ventricular ejection fraction below 40% on echocardiography (Simpson method), hemodynamically significant valvular disease defined as any mitral valve stenosis, aortic valve stenosis with a pressure gradient of 30 mm Hg or greater, mitral or aortic valve regurgitation higher than grade 1/4, or pulmonary hypertension higher than 35 mm Hg.17 Patients with signs of myocardial ischemia on stress testing, defined as more than 1 mm of ST-segment depression in at least 2 electrocardiographic limb leads or more than 2 mm in at least 2 precordial leads with or without anginal complaints, were also excluded. Six patients were excluded because of abnormal stress test results (n=3) and valvular disease (n=3), leaving 32 patients who were enrolled in the trial. Six patients, 5 from the withdrawal group and 1 from the continuation group, did not complete the trial and restarted respectively augmented furosemide therapy. In 2 patients, the E/A ratio was found to be greater than 1.0, indicating a restrictive left ventricular diastolic filling pattern. In 1 patient, no reliable BP measurement (Finapres [finger arterial pressure]; Dutch Organization for Applied Technology, Amsterdam, the Netherlands) could be obtained. No tests could be performed in 3 patients for logistical reasons, leaving 20 patients who were included in this study.