Effects of short-acting and long-acting loop diuretics on heart rate variability in patients with chronic compensated congestive heart failure.
BACKGROUND
We investigated the effects of a short-acting loop diuretic (furosemide) and a long-acting loop diuretic (azosemide) on heart rate variability, fluid balance, and neurohormonal responses in patients with mild to moderate chronic congestive heart failure.


METHODS
Nineteen patients with mild to moderate chronic congestive heart failure received furosemide (40 to 60 mg/day) or azosemide (60 to 90 mg/day) for 5 days in a crossover manner. We performed time-domain and frequency-domain analyses of 24-hour Holter electrocardiographic recordings to assess heart rate variability.


RESULTS
The 24-hour urinary sodium excretion was similar during the furosemide and azosemide treatment periods but was significantly greater in the first 2 hours after drug administration during furosemide treatment. Plasma renin activity and the hematocrit level increased and high-frequency power significantly decreased 2 hours after the administration of furosemide only. The standard deviation of all normal R-R intervals and the root mean square of successive differences in the R-R interval were lower with furosemide than with azosemide (P <.05).


CONCLUSIONS
Furosemide, a short-acting loop diuretic, has a greater influence on heart rate variability and fluid balance than azosemide, a long-acting loop diuretic, in patients with mild to moderate chronic congestive heart failure.
Division of Cardiology, Department of Internal Medicine, Teikyo University Ichihara Hospital, Chiba, Japan. h-tomiya@medteikyo-u.ac.jp
H
H
Tomiyama
T
T
Nakayama
G
G
Watanabe
K
K
Shiojima
Y
Y
Sakuma
A
A
Yamamoto
Y
Y
Imai
H
H
Yoshida
N
N
Doba
D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D002908:Chronic Disease; D018592:Cross-Over Studies; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D018619:Echocardiography, Doppler, Pulsed; D015716:Electrocardiography, Ambulatory / Q000187:drug effects; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects*; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000502:physiology; D012083:Renin / Q000097:blood; D016037:Single-Blind Method; D012964:Sodium / Q000652:urine; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D013424:Sulfanilamides / Q000008:administration & dosage / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology; D014882:Water-Electrolyte Balance / Q000187:drug effects; D013777:Tetrazoles; D013876:Thiophenes; D000096926:Benzenesulfonamides
D004232:Diuretics; D005665:Furosemide; D018377:Neurotransmitter Agents; D012083:Renin; D012964:Sodium; D013424:Sulfanilamides; C018222:azosemide; D013777:Tetrazoles; D013876:Thiophenes; D000096926:Benzenesulfonamides