Placebo-controlled withdrawal of furosemide therapy significantly lessened the maximum postprandial systolic blood pressure decline from -25 to -11 mm Hg (P<0.001).
RCT (n=20)
Placebo-controlled
Does furosemide withdrawal improve postprandial blood pressure in elderly patients with heart failure and preserved left ventricular systolic function?
Withdrawal of furosemide in elderly patients with HFpEF ameliorates postprandial hypotension, likely by improving left ventricular diastolic filling.
p-value: p=<.001
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.
Kraaij et al. (1999) conducted an RCT in Heart failure with preserved left ventricular systolic function (n=20). Furosemide withdrawal vs. Continuation of furosemide therapy was evaluated on Maximum postprandial systolic blood pressure decline (p=<.001). Placebo-controlled withdrawal of furosemide therapy significantly lessened the maximum postprandial systolic blood pressure decline from -25 to -11 mm Hg (P<0.001).