title: A double-blind, cross-over comparison of the effects of a loop diuretic and a dopamine receptor agonist as first line therapy in patients with mild congestive heart failure.
abstract: We compared the effects of the orally active dopamine agonist ibopamine with the loop diuretic frusemide as first-line therapy in patients with mild congestive heart failure. Fourteen patients with New York Heart Association class II congestive heart failure were enrolled in a double-blind, cross-over study. After baseline measurements of clinical and symptomatic status, modified Bruce exercise time, high-level exercise time, corridor walk time, regional blood flow, pedometer scores, 24 h urine volume and sodium excretion and neurohumoural factors, patients were randomly allocated to receive either frusemide 40 mg o.d. or ibopamine 100 mg t.d.s. for 8 weeks. Assessments were performed at 2 weekly intervals. After 8 weeks, patients crossed over into the alternate treatment arm for a further 8 weeks, with further assessments performed every 2 weeks. There were four exacerbations of heart failure during ibopamine treatment and none during frusemide treatment. After 8 weeks of treatment, modified Bruce exercise time was 901 +/- 73 s with frusemide and 646 +/- 134 s with ibopamine (P < 0.05). Twenty-four hour urinary sodium excretion at weeks 2 and 4 (P < 0.05), and 24 h urinary volume at week 2 (P = 0.0001) were lower during ibopamine treatment. At week 8, supine (P = 0.076) and erect renin (P = 0.05) were lower with ibopamine treatment. In conclusion, ibopamine is ineffective as first line therapy for congestive heart failure, probably because of a lesser diuretic potency than frusemide.
authors.affiliation: Department of Cardiovascular Medicine, University Hospital, Nottingham, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Andrews
authors.forename: A
authors.initials: A
authors.lastname: Charlesworth
authors.forename: A
authors.initials: A
authors.lastname: Evans
authors.forename: A J
authors.initials: AJ
authors.lastname: Cowley
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D003846:Deoxyepinephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D018491:Dopamine Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D004232:Diuretics; D018491:Dopamine Agonists; D005665:Furosemide; C023487:ibopamine; D003846:Deoxyepinephrine