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Sequential neurohumoral measurements in patients with congestive heart failure
G S Francis1, T S Rector, J N Cohn
1Department of Medicine, Veterans Administration Medical Center, Minneapolis, MN 55417.
Insights
Chronic heart failure patients show increasing neurohormonal activation over time, regardless of treatment. Plasma norepinephrine and renin activity rise progressively, indicating ongoing sympathetic nervous system and renin-angiotensin-aldosterone system activation.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Patients with chronic congestive heart failure (CHF) exhibit elevated plasma norepinephrine and renin activity.
- Understanding neurohumoral changes over time is crucial for managing CHF.
Purpose of the Study:
- To evaluate longitudinal changes in plasma norepinephrine and plasma renin activity in patients with chronic, stable CHF.
- To compare neurohumoral activation trends between patients receiving converting enzyme inhibitors and those not.
Main Methods:
- 49 patients with chronic, stable CHF were monitored.
- Plasma norepinephrine and renin activity were measured at baseline and sequentially during follow-up.
- Patients were categorized into two groups: those receiving converting enzyme inhibitors (n=22) and those not (n=27).
Main Results:
- Both groups showed a significant positive trend in plasma norepinephrine over time.
- Patients not on converting enzyme inhibitors (group II) exhibited a progressive upward trend in plasma renin activity.
- These findings indicate a significant trend of neurohumoral activation over time in stable CHF patients.
Conclusions:
- Chronic, stable congestive heart failure is associated with progressive neurohumoral activation.
- This activation occurs irrespective of adjunctive therapy, including converting enzyme inhibitors.
- Long-term monitoring of neurohumoral markers may be important in managing CHF.
Abstract:
Patients with chronic congestive heart failure are known to have increased plasma norepinephrine and plasma renin activity. In order to evaluate neurohumoral changes over time, we measured plasma norepinephrine and plasma renin activity at baseline and sequentially during follow-up in 49 patients with chronic, stable congestive heart failure. All patients were treated with digitalis and diuretics. Converting enzyme inhibitor therapy was prescribed as adjunctive therapy in 22 patients, while 10 patients were taking hydralazine and/or isosorbide dinitrate, seven were taking prazosin, and 10 had no adjunctive therapy. Patients were divided into those taking converting enzyme inhibitors (group I, n = 22) and those not taking converting enzyme inhibitors (group II, n = 27). Group I was followed for a median (25th to 75th percentiles) of 24.3 (18 to 27.9) months, while group II was followed for 18.7 (11.9 to 36.5) months. Results indicate that patients in group I demonstrate a significant positive trend for rise in plasma norepinephrine of 11.7 pg/ml per month (7.8 to 15 pg/ml per month, 95% confidence interval). Patients in group II also demonstrated a significant positive trend in plasma norepinephrine over time of 6.6 pg/ml per month (2.2 to 11.1 pg/ml per month). Moreover, there was a progressive trend upward in plasma renin activity over time in group II (median 0.34 ng/ml/hr per month; range 0.13 to 0.54). The data indicate that there is a significant trend of neurohumoral activation over time in patients with chronic, clinically stable congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)