Interaction of intravenous atrial natriuretic factor with furosemide in patients with heart failure.
Furosemide is frequently administered intravenously to patients with chronic heart failure. However, use of diuretics may cause neuroendocrine activation and by itself may not consistently afford diuresis. Atrial natriuretic factor (ANF) in pharmacologic doses is a vasodilator and has favorable neuroendocrinologic effects in patients with congestive heart failure. To examine whether exogenous ANF might enhance the effects of acute furosemide injection, we studied 14 patients with chronic stable heart failure and measured the effects of the combination of ANF and furosemide on hemodynamics, neuroendocrine activation, and urine output. Eight patients were randomly assigned to receive placebo plus furosemide (1.3 mg/kg intravenously). Six patients received ANF (2 micrograms/kg intravenously) plus furosemide at the same dose in a double-blind manner. The group receiving placebo plus furosemide exhibited a slight increase in mean arterial pressure (92 to 96 mm Hg; p < 0.03), systemic vascular resistance (1989 to 2271 dynes.sec.cm-5; p = 0.0007), and pulmonary capillary wedge pressure (22 to 24 mm Hg; p < 0.04) from baseline to 10 minutes. The group receiving ANF plus furosemide exhibited no change in mean arterial pressure and systemic vascular resistance from baseline to 10 minutes. Pulmonary capillary wedge pressure and mean pulmonary pressure were unchanged. In the group receiving placebo plus furosemide.(ABSTRACT TRUNCATED AT 250 WORDS)
Connelly
T P
TP
Department of Medicine, University of Minnesota Medical School, Minneapolis 55455.
Francis
G S
GS
Williams
K J
KJ
Beltran
A M
AM
Cohn
J N
JN
D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004311:Double-Blind Method; D004347:Drug Interactions; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use*; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010919:Placebos; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D012083:Renin / Q000097:blood; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D010919:Placebos; D005665:Furosemide; D009320:Atrial Natriuretic Factor; D012083:Renin; D009638:Norepinephrine