title: Hypotension is associated with diuretic resistance in severe chronic heart failure, independent of renal function.
abstract: BACKGROUND
  Diuretic resistance and systemic hypotension are common in chronic heart failure (CHF), however, the two have not been associated.
  
  
  OBJECTIVE
  Since blood pressure (BP) might be an important determinant of sodium excretion, we searched for an association between BP and diuretic dosage in severe CHF.
  
  
  METHODS
  Our heart failure database was retrospectively reviewed for patients with severe left ventricular systolic dysfunction. The 54-patient cohort was divided on the basis of frusemide dosage (high-dose > or = 250 mg daily, n=26).
  
  
  RESULTS
  Patients taking high-dose frusemide had higher serum creatinine, and lower systolic and diastolic BP. On logistic regression analysis, increased serum creatinine and reduced diastolic BP were independent predictors of the use of high-dose frusemide. Grouping these variables into tertiles, the odds ratio for the use of high-dose frusemide was 4.0 as diastolic BP decreased (p<0.01), and 6.8 as serum creatinine increased (p<0.001).
  
  
  CONCLUSIONS
  We have found an association between hypotension and the use of high-dose frusemide in severe CHF, which is independent of renal function, and which may be an important physiologic mechanism of diuretic resistance in severe CHF.
authors.affiliation: Cardiac Services, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, South Australia, Australia. carmine.depasquale@fmc.sa.gov.au
authors.forename: C G
authors.initials: CG
authors.lastname: De Pasquale
authors.forename: J S
authors.initials: JS
authors.lastname: Dunne
authors.forename: R B
authors.initials: RB
authors.lastname: Minson
authors.forename: L F
authors.initials: LF
authors.lastname: Arnolda
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000378:metabolism; D004232:Diuretics / Q000494:pharmacology* / Q000627:therapeutic use; D025461:Feedback, Physiological / Q000502:physiology; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008875:Middle Aged; D012189:Retrospective Studies; D012964:Sodium / Q000652:urine; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide; D012964:Sodium; D003404:Creatinine