title: Natriuretic and neurohormonal responses to nesiritide, furosemide, and combined nesiritide and furosemide in patients with stable systolic dysfunction.
abstract: BACKGROUND
  In patients with heart failure, few data describe the neurohormonal response to nesiritide and furosemide either alone or in combination. This study systematically compared the effects of nesiritide, furosemide, and their combination on natriuresis/diuresis and plasma aldosterone in patients with chronic stable heart failure who were relatively diuretic resistant.
  
  
  OBJECTIVE
  Natriuretic, diuretic, and neurohormonal responses to furosemide and nesiritide will differ when these agents are administered alone vs. in combination.
  
  
  METHODS
  Twenty-eight subjects completed a multicenter, open-label, three-arm crossover study. Each subject received the following treatments in random order on alternate days: (1) furosemide, 40 mg intravenous bolus; (2) nesiritide, 2 microg/kg intravenous bolus followed by a 0.01 microg/kg/min infusion for 6 hours; (3) both furosemide and nesiritide, with furosemide given at least 15 minutes after initiation of nesiritide.
  
  
  RESULTS
  Plasma aldosterone increased by 2.2 +/- 1.6 ng/dL after furosemide alone, decreased by 3.9 +/- 1.6 ng/dL after nesiritide alone (P = 0.005 vs furosemide alone and P = 0.56 vs furosemide plus nesiritide), and decreased by 2.8 +/- 1.6 ng/dL after furosemide plus nesiritide (P = 0.02 vs furosemide alone).
  
  
  CONCLUSIONS
  Furosemide alone produced natriuresis/diuresis and a prompt rise in plasma aldosterone values. Nesiritide alone produced no significant natriuresis/diuresis, but decreased plasma aldosterone values. When furosemide was administered on a background of nesiritide infusion, the observed natriuresis/diuresis was similar to that seen with furosemide alone, without the anticipated increase in plasma aldosterone observed with furosemide alone.
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Domenic
authors.initials: D
authors.lastname: Sica
authors.forename: Ron M
authors.initials: RM
authors.lastname: Oren
authors.forename: Mildred D
authors.initials: MD
authors.lastname: Gottwald
authors.forename: Roger M
authors.initials: RM
authors.lastname: Mills
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D018592:Cross-Over Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects*; D045283:Natriuretic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage / Q000627:therapeutic use*; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D018754:Ventricular Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016276:Ventricular Function
chemical_list: D015415:Biomarkers; D045283:Natriuretic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D005665:Furosemide