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European Heart Journal 1997 18(5):852-857;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

A double-blind, cross-over comparison of the effects of a loop diuretic and a dopamine receptor agonist as first line therapy in patients with mild congestive heart failure

R. Andrews, A. Charlesworth*, A. Evans and A. J. Cowley

Department of Cardiovascular Medicine, University Hospital Nottingham, U.K.
*Nottingham Clinical Trial Data Centre Nottingham, U.K.

revised 19 June 1996; accepted 28 June 1996.

Correspondence: Dr A. J. Cowley. Department of Cardiovascular Medicine, Queen's Medical Centre, Nottingham, NG7 2UH, U.K.

Abstract

We compared the effects of the orally active dopamine agonist ibopamine with the loop diuretic frusemide as first-line therapy in patients with mild congestive heart failure. Fourteen patients with New York Heart Association class II congestive heart failure were enrolled in a double-blind, cross-over study. After baseline measurements of clinical and symptomatic status, modified Bruce exercise time, high-level exercise time, corridor walk time, regional blood flow, pedometer scores, 24 h urine volume and sodium excretion and neurohumoural factors, patients were randomly allocated to receive either frusemide 40 mg o.d. or ibopamine 100 mg t.d.s. for 8 weeks. Assessments were performed at 2 weekly intervals. After 8 weeks, patients crossed over into the alternate treatment arm for a further 8 weeks, with further assessments performed every 2 weeks.

There were four exacerbations of heart failure during ibopamine treatment and none during frusemide treatment.

After 8 weeks of treatment, modified Bruce exercise time was 901 ± 73 s with frusemide and 646 ± 134 s with ibopamine (P<0·05). Twenty-four hour urinary sodium excretion at weeks 2 and 4 (P<0·05), and 24 h urinary volume at week 2 (P=0·0001) were lower during ibopamine treatment. At week 8, supine (P=0·076) and erect renin (P=0·05) were lower with ibopamine treatment.

In conclusion, ibopamine is ineffective as first line therapy for congestive heart failure, probably because of a lesser diuretic potency than frusemide.

Key Words: Congestive heart failure • loop diuretics • dopamine receptor agonist • drug therapy • ibopamine • frusemide


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