Furosemide withdrawal improves postprandial hypotension in elderly patients with heart failure and preserved left ventricular systolic function

Objective: To assess the effects of furosemide withdrawal on postprandial b lood pressure (BP) in elderly patients with heart failure and preserved lef t ventricular systolic function. Methods: Noninvasive measurement of blood pressure (BP) and heart rate, com putation of stroke volume and cardiac output (after a 1247-kJ (297-kcal) me al, and Doppler echocardiography before and 3 months after placebo-controll ed withdrawal of furosemide therapy. Results: Of 20 patients with heart failure (mean +/- SEM age, 75 +/- 1 year s; left ventricular ejection fraction, 61% +/- 3%), 13 were successfully ab le to discontinue furosemide therapy. At baseline, 11 (55%) of the 20 patie nts (had maximum postprandial systolic BP declines of 20 mm Hg or more. In the withdrawal group, the maximum systolic BP decline lessened from -25 +/- 4 to -11 +/- 2 mm Hg (P < .001) and the maximum diastolic BP from -18 +/- 3 to -9 +/- 1 mm Hg (P = .01), compared with no changes in the continuation group. In the withdrawal group, maximum postprandial declines in stroke vo lume and cardiac output decreased from -9 +/- 1 to -4 +/- 2 mt (P = .01) an d from -0.6 +/- 0.2 to -0.2 +/- 0.1 L/min) (P = .04), respectively. The bas eline maximum postprandial systolic BP decrease was correlated with the rat io of early to late flow (n = 20; Spearman rank correlation coefficient, 0. 58; P = .007). For patients in the withdrawal group, the changes in postpra ndial systolic BP response were independently related to changes in peak ve locity of early flow (n = 13; r(2) = 0.61; P = .003). Conclusions: Postprandial hypotension is common in elderly patients with he art failure and preserved left ventricular systolic function. The withdrawa l of furosemide therapy ameliorates postprandial BP homeostasis in these pa tients, possibly by improving left ventricular diastolic filling.