This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (17)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic

Dave J. W. van Kraaij, MD; René W. M. M. Jansen, MD, PhD; Léon H. R. Bouwels, MD; Willibrord H. L. Hoefnagels, MD, PhD

Arch Intern Med. 1999;159:1599-1605.

Objective  To assess the effects of furosemide withdrawal on postprandial blood pressure (BP) in elderly patients with heart failure and preserved left ventricular systolic function.

Methods  Noninvasive measurement of blood pressure (BP) and heart rate, computation of stroke volume and cardiac output ( after a 1247-kJ (297-kcal) meal, and Doppler echocardiography before and 3 months after placebo-controlled withdrawal of furosemide therapy.

Results  Of 20 patients with heart failure (mean ± SEM age, 75±1 years; left ventricular ejection fraction, 61%±3%), 13 were successfully able to discontinue furosemide therapy. At baseline, 11 (55%) of the 20 patients (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 volume and cardiac output decreased from -9±1 to -4±2 mL (P=.01) and from -0.6±0.2 to -0.2±0.1 L/min) (P=.04), respectively. The baseline maximum postprandial systolic BP decrease was correlated with the ratio of early to late flow (n=20; Spearman rank correlation coefficient, 0.58; P=.007). For patients in the withdrawal group, the changes in postprandial systolic BP response were independently related to changes in peak velocity of early flow (n=13; r²=0.61; P=.003).

Conclusions  Postprandial hypotension is common in elderly patients with heart failure and preserved left ventricular systolic function. The withdrawal of furosemide therapy ameliorates postprandial BP homeostasis in these patients, possibly by improving left ventricular diastolic filling.

From the Department of Geriatric Medicine, University Hospital Nijmegen (Drs van Kraaij, Jansen, and Hoefnagels), and the Department of Cardiology, Canisius-Wilhelmina Hospital (Dr Bouwels), Nijmegen, the Netherlands.

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(14):1630-1631.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Postprandial Hypotension: Simple Treatment But Difficulties With the Diagnosis
Jansen
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:1268-1270.
FULL TEXT  

High Prevalence of Postprandial and Orthostatic Hypotension Among Geriatric Patients Admitted to Dutch Hospitals
Vloet et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:1271-1277.
ABSTRACT | FULL TEXT  

Intraduodenal Guar Attenuates the Fall in Blood Pressure Induced by Glucose in Healthy Older Adults
O'Donovan et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:940-946.
ABSTRACT | FULL TEXT  

AUTHORS' RESPONSE
Vloet and Jansen
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:185-186.
FULL TEXT  

The Effect of Meals at Different Mealtimes on Blood Pressure and Symptoms in Geriatric Patients With Postprandial Hypotension
Vloet et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M1031-1035.
ABSTRACT | FULL TEXT  

Editorial: Postprandial Hypotension--The Ultimate Big Mac Attack
Morley
J. Gerontol. A Biol. Sci. Med. Sci. 2001;56:M741-743.
FULL TEXT  

The Influence of Low-, Normal-, and High-Carbohydrate Meals on Blood Pressure in Elderly Patients With Postprandial Hypotension
Vloet et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2001;56:M744-748.
ABSTRACT | FULL TEXT