Copyright © 1988 by the European Society of Cardiology.
© 1988 The European Society of Cardiology
The effects of frusemide and angiotensin-converting enzyme inhibitors and their combination on cardiac and renal haemodynamics in heart failure
Department of Cardiology, Western Infirmary Glasgow, U.K.
Received 17 February 1987; revised 27 July 1987; .
address for correspondence: John G. F. Cleland, Senior Registrar, Dept of Cardiology, Hammersmith Hospital, London W12, U.K.
Abstract
Few studies exist on the interaction of diuretics and angiotensin-converting enzyme inhibitors in patients with chronic heart failure. Twelve subjects with heart failure were studied before and after their usual oral dose of frusemide in random order on consecutive days during fixed sodium, potassium and water intake. Patients then received 10 mg day –1 of enalapril for 5 days and subsequently restudied before and after their usual dose of frusemide.
Frusemide was not observed to have an effect on systemic or renal haemodynamics prior to enalapril, but urine volume and sodium content rose as expected. Treatment with enalapril, in the absence of frusemide, was associated with a fall in mean blood pressure from 89 ±5 mmHg to 85 ±4 mmHg (P < 0.02) and a rise in renal blood flow from 424 ±202 ml min–1 to 494±225ml min–1 (P<0.02), but cardiac output and glomerular filtration rate were again unchanged. Addition of frusemide to enalapril therapy resulted in a greater fall in mean blood pressure (87±5mmHg to 79±4 mmHg; P<001) and an increase in cardiac output (3.1 ± 11 lmin-1 to 3.6± 1.01 min–1; P<0.02). Renal blood flow increased further than after enalapril alone to 579 ±211 ml min–1 but the glomerular filtration rate fell to 63±26 ml min–1 (P<0.01) and the filtration fraction fell to 19±5% (P<0.001). Weight gain occurred and the diuretic response to frusemide was reduced during this early phase of enalapril therapy.
Key Words: Angiotensin-converting enzyme inhibitor • heart failure • frusemide • renal effects
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