title: [Basic therapy of chronic heart failure with digitalis or diuretics?].
abstract: Sixteen patients in heart failure and sinus rhythm were, after a four-week treatment-free period, randomly assigned to receive, for four to six weeks, either a diuretic combination (hydrochlorothiazide + triamterene) or a digitalis glycoside. Subsequently the treatment was exchanged between the two groups. Without treatment nine patients were in stage II (New York Heart Association classification), seven in stage III. Pulmonary wedge pressure at rest was 27 +/- 14, on exercise 32 +/- 8 mm Hg, cardiac output 5.3 +/- 1.0 at rest and 7.8 +/- 2.3 l/min on exercise. Digitalis glycosides improved symptoms by one stage in three of 16 patients. All objective measures showed slight but not significant improvement. Diuretic treatment improved symptoms in five patients, while heart size and echocardiographically measured ventricular volume decreased slightly. Cardiac output decreased at rest, but not significantly, and on exercise not at all. Pulmonary arterial pressure (21 +/- 9 mm Hg), pulmonary wedge pressure (13 +/- 7 mm Hg) and pulmonary artery pressure on exercise (39 +/- 11 mm Hg) were significantly lower on diuretics than without treatment. The results support the primary use of diuretics in the treatment of chronic heart failure.
authors.affiliation: Abteilung für Kardiologie, Universität Frankfurt/Main.
authors.forename: H
authors.initials: H
authors.lastname: Sievert
authors.forename: T
authors.initials: T
authors.lastname: Offermann
authors.forename: R
authors.initials: R
authors.lastname: Hopf
authors.forename: M
authors.initials: M
authors.lastname: Kaltenbach
authors.forename: W D
authors.initials: WD
authors.lastname: Bussmann
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004071:Digitalis Glycosides / Q000627:therapeutic use*; D004074:Digitoxin / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D004338:Drug Combinations; D004341:Drug Evaluation; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014223:Triamterene / Q000627:therapeutic use*
chemical_list: D004071:Digitalis Glycosides; D004338:Drug Combinations; D006852:Hydrochlorothiazide; D004077:Digoxin; D004074:Digitoxin; D014223:Triamterene
vernacular_title: Basistherapie der chronischen Herzinsuffizienz mit Digitalis oder Diuretika?