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[Basic therapy of chronic heart failure with digitalis or diuretics?]
H Sievert1, T Offermann, R Hopf
1Abteilung für Kardiologie, Universität Frankfurt/Main.
Insights
Diuretics significantly reduced pulmonary pressures in chronic heart failure patients, offering a primary treatment option over digitalis glycosides. This study highlights diuretics for improved heart failure management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic heart failure (CHF) management remains a clinical challenge.
- Current treatments aim to improve symptoms and reduce mortality.
- Understanding the comparative efficacy of different drug classes is crucial.
Purpose of the Study:
- To compare the efficacy of a diuretic combination (hydrochlorothiazide + triamterene) versus a digitalis glycoside in patients with heart failure and sinus rhythm.
- To evaluate the impact of these treatments on clinical symptoms and objective hemodynamic parameters.
Main Methods:
- A randomized crossover study involving 16 patients with heart failure and sinus rhythm.
- Patients received either a diuretic combination or a digitalis glycoside for 4-6 weeks, followed by a crossover to the other treatment after a washout period.
- Hemodynamic measurements including pulmonary wedge pressure and cardiac output were assessed at rest and during exercise.
Main Results:
- Diuretic treatment significantly lowered pulmonary arterial pressure, pulmonary wedge pressure, and pulmonary artery pressure during exercise compared to no treatment.
- Digitalis glycosides showed a modest, non-significant improvement in objective measures and symptoms in a subset of patients.
- Diuretics improved symptoms in five patients and led to slight reductions in heart size and ventricular volume.
Conclusions:
- Diuretics demonstrate significant hemodynamic benefits in managing chronic heart failure, particularly in reducing pulmonary pressures.
- The findings support the primary use of diuretics in the treatment of chronic heart failure.
- Further research may explore optimal diuretic strategies in heart failure management.
Abstract:
Sixteen patients in heart failure and sinus rhythm were, after a four-week treatment-free period, randomly assigned to receive, for four to six weeks, either a diuretic combination (hydrochlorothiazide + triamterene) or a digitalis glycoside. Subsequently the treatment was exchanged between the two groups. Without treatment nine patients were in stage II (New York Heart Association classification), seven in stage III. Pulmonary wedge pressure at rest was 27 +/- 14, on exercise 32 +/- 8 mm Hg, cardiac output 5.3 +/- 1.0 at rest and 7.8 +/- 2.3 l/min on exercise. Digitalis glycosides improved symptoms by one stage in three of 16 patients. All objective measures showed slight but not significant improvement. Diuretic treatment improved symptoms in five patients, while heart size and echocardiographically measured ventricular volume decreased slightly. Cardiac output decreased at rest, but not significantly, and on exercise not at all. Pulmonary arterial pressure (21 +/- 9 mm Hg), pulmonary wedge pressure (13 +/- 7 mm Hg) and pulmonary artery pressure on exercise (39 +/- 11 mm Hg) were significantly lower on diuretics than without treatment. The results support the primary use of diuretics in the treatment of chronic heart failure.