RT Journal
A1 van Kraaij DW, Jansen RM, Bouwels LR, Hoefnagels WL
T1 FUrosemide withdrawal improves postprandial hypotension in elderly patients with heart failure and preserved left ventricular systolic function
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD July 26
VO 159
IS 14
SP 1599
OP 1605
DO 10.1001/archinte.159.14.1599
UL http://dx.doi.org/10.1001/archinte.159.14.1599
AB Objective 
    To assess the effects of furosemide withdrawal on postprandial blood pressure (BP) in elderly patients with heart failure and preserved left ventricular systolic function.Methods 
    Noninvasive measurement of blood pressure (BP) and heart rate, computation of stroke volume and cardiac output (after a 1247-kJ (297-kcal) meal, and Doppler echocardiography before and 3 months after placebo-controlled withdrawal of furosemide therapy.Results 
    Of 20 patients with heart failure (mean ± SEM age, 75±1 years; left ventricular ejection fraction, 61%±3%), 13 were successfully able to discontinue furosemide therapy. At baseline, 11 (55%) of the 20 patients (had maximum postprandial systolic BP declines of 20 mm Hg or more. In the withdrawal group, the maximum systolic BP decline lessened from −25±4 to −11±2 mm Hg (P<.001) and the maximum diastolic BP from −18±3 to −9±1 mm Hg (P=.01), compared with no changes in the continuation group. In the withdrawal group, maximum postprandial declines in stroke volume and cardiac output decreased from −9±1 to −4±2 mL (P=.01) and from −0.6±0.2 to −0.2±0.1 L/min) (P=.04), respectively. The baseline maximum postprandial systolic BP decrease was correlated with the ratio of early to late flow (n=20; Spearman rank correlation coefficient, 0.58; P=.007). For patients in the withdrawal group, the changes in postprandial systolic BP response were independently related to changes in peak velocity of early flow (n=13; r2=0.61; P=.003).Conclusions 
    Postprandial hypotension is common in elderly patients with heart failure and preserved left ventricular systolic function. The withdrawal of furosemide therapy ameliorates postprandial BP homeostasis in these patients, possibly by improving left ventricular diastolic filling.