Furosemide withdrawal in elderly heart failure patients with preserved left ventricular systolic function

To explore the possibilities of furosemide withdrawal in elderly heart fail ure (HF) patients with intact left ventricular (LV) systolic function and a ssess its effects on functional status and orthostatic blood pressure homeo stasis, we performed a placebo-controlled pilot trial of furosemide withdra wal with 3 months of follow-up in 32 HF patients (aged 75.1 +/- 0.7 years [ mean +/- SEM]) with a LV ejection fraction of 60 +/- 2% and without overt c ongestion. Investigations included repeated clinical assessment, spirometry , standardized 6-minute walking test, and chest x-rays, Measurements of blo od pressure response on active standing and Doppler echocardiography were p erformed before and 3 months after furosemide withdrawal. Recurrent congest ive HF occurred in 2 of 21 patients (10%) who discontinued furosemide use, and in 1 of 11 patients (9%) who continued furosemide (p = NS), Three patie nts restarted furosemide for ankle edema and 1 for blood pressure levels >1 80/100 mm Hg. After 3 months, there were no differences regarding HF sympto m scores, blood pressure, heart rate, spirometric results, 6-minute walking distance, or quality of life scores between patients who discontinued use and patients who continued the therapy. In patients successfully withdrawn, Doppler E/A ratio increased from 0.68 +/- 0.05 to 0.79 +/- 0.06 after with drawal (p < 0.01), and maximum blood pressure decrease on active standing c hanged from -8 +/- 5 mm Hg to +5 +/- 3 mm Hg systolic (p < 0.05). Thus, in this pilot investigation of furosemide withdrawal in elderly HF patients wi thout overt congestion and with a normal LV systolic function, withdrawal w as successful in almost all patients and was associated with improvement of LV diastolic filling and blood pressure homeostasis on active standing. (C ) 2000 by Excerpta Medica, Inc.