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Acute and chronic effects of a diuretic monotherapy with piretanide in congestive heart failure—A placebo-controlled trial

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To evaluate the acute and chronic effects of diuretic monotherapy with 3 mg piretanide bid, 46 patients (pts) with congestive heart failure (NYHA II-III) secondary to coronary artery disease were studied. Within 3 weeks of therapy, the patients lost 1.6 kg body weight. Forty-four patients reported a subjective feeling of improvement. Echocardiographically, a highly significant (p<0.001) reduction of diastolic and systolic diameters was found, as well as an increase of fraction shortening. Chest x-ray indicated a reduction of heart volume from 1012±263 ml to 936±233 ml (p<0.001). The serum potassium level remained unchanged. A subgroup of 26 pts underwent invasive hemodynamic examinations. IV injection of 6 mg piretanide resulted in an acute reduction of pulmonary wedge pressure (pc) from 20.2±5.3 mmHg to 11.9±5.0 mmHg (p<0.001); simultaneously a slight decrease of cardiac index from 3.2±0.6 l/min/m2 to 3.0±0.4 l/min/m2 was observed. Invasive control after 3 weeks of oral therapy showed no decline of the piretanide effect. The exercise tolerance increased clearly from 135±161 Wmin to 249±268 Wmin (p<0.05). A control group of further 14 pts was treated with placebo only and did not show any significant changes of pc (20.0±6.4 mmHg vs. 22.8±19.2 mmHg), exercise tolerance, or other clinical parameters. Thus, the diuretic monotherapy of congestive heart failure with piretanide is highly effective and shows a significant improvement in all clinical and hemodynamic parameters in the absence of any remarkable side effects.

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  1. 1.

    Dollery CT, Corr L. Drug treatment of heart failure.Br Heart J 1985;54:234–242.

  2. 2.

    Beller GA, Smith TW, Abelmann WH, et al. Digitalis intoxication. A prospective clinical study with serum level correlations.N Engl J Med 1971;284:989–997.

  3. 3.

    Taylor SH, Storstein L. Diuretics in the treatment of heart failure.Herz 1983;8:11–22.

  4. 4.

    Hesse B, Nielson I, Lund-Jacobsen H. The early effects of intravenous frusemide on central haemodynamics, venous tone and plasma renin activity.Clin Sci Molc Med 1975;49:551–555.

  5. 5.

    Ikram H. Haemodynamic and hormone response to acute and chronic frusemide therapy in congestive heart failure.Clin Sci 1980;59:443–449.

  6. 6.

    Francis GS, Siegel RM. Goldsmith SR, et al. Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure.Ann Intern Med 1985;103:1–6.

  7. 7.

    Biddle TL, Yu BN. Effect of furosemide on haemodynamics and lung water in acute pulmonary oedema secondary to myocardial infarction.Am J Cardiol 1979;43:86–90.

  8. 8.

    Davidson RM, Goldman J, Whalen RE, et al. Haemodynamic effects of furosemide in acute myocardial infarction.Circulation 1971;44(Suppl II):156.

  9. 9.

    Dikshit K, Vyden JK, Forrester JS, et al. Renal and extrarenal haemodynamic effects of furosemide in congestive heart failure after myocardial infarction.N Engl J Med 1973;288:1087–1090.

  10. 10.

    Kiely J, Kelly DT, Taylor DR, et al. The role of furosemide in the treatment of left ventricular dysfunction associated with acute myocardial infarction.Circulation 1973;48:581–587.

  11. 11.

    Bauer U, Frick G, Mouselimis N, et al. Akuter und chronischer effekt von piretanid auf die hämodynamik herzinsuffizienter patienten mit koronarer herzerkrankung.Herz/Kreisl 1983;15:493–500.

  12. 12.

    Rader B, Smith WW, Barger AR, et al. Comparison of the haemodynamic effects of mercurial diuretics and digitalis in congestive heart failure.Circulation 1964;29:328–345.

  13. 13.

    Stampfer M, Epstein SE, Beiser GD, et al. Haemodynamic effects of diuresis at rest and during intense upright exercise in patients with impaired cardiac function.Circulation 1968;37:900–911.

  14. 14.

    Gupta PS, Dare ML, Piretanide (Hoe 118): A new diuretic in essential hypertension.Curr Ther Res 1981;30:468–476.

  15. 15.

    Valette H, Hebert JL, Raffestin B, et al. Comparison of haemodynamic effects of furosemide and piretanide in normovolemic patients.J Cardiovasc Pharmacol 1980;2:103–111.

  16. 16.

    Klaus E, Alpermann HG, Caspritz G, et al. Vascular effects of piretanide.Arueim Forsch. (Drug Res) 1983;33:1273–1276.

  17. 17.

    Teredesai P, Puschett JB. Acute effects of piretanide in normal subjects.Clin Pharmacol Ther 1979;25:331–339.

  18. 18.

    McKee PA, Costelli WP, McNamara PM, et al. The natural history of congestive heart failure; the Framingham study.N Engl J Med 1971;285:1441–1446.

  19. 19.

    Watzke K, Frisch P, Klepzig H. Eine vereinfachte methode der radiologischen herzgrößenbestimmung.Münch Med Wochenschr 1973;47:2146–2150.

  20. 20.

    Hutcheon DE. Martinez JC. A decade of developments in diuretic drug therapy.J Clin Pharmacol 1986;26:567–579.

  21. 21.

    Marsh JD, Nesto R, Glynn MA, et al. Comparison of intravenous piretanide and furosemide in patients with congestive heart failure.J Cardiovase Pharmacol 1982;4:949–954.

  22. 22.

    Margini F, Niarchos AP. Ineffectiveness of sublingual nitroglycerin in acute left ventricular failure in the presence of massive peripheral edema.Am J Cardiol 1980:45:841–847.

  23. 23.

    Hasenfuss G, Holubarsch C, Herzog C et al. Influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide.Clin Cardiol 1987;10:83–88.

  24. 24.

    Verho M, Heintz B Nelson K, et al. The effects of piretanide on catecholamine metabolism, plasma renin activity and plasma aldosterone: A double blind study versus furosemide in healthy volunteers.Curr Med Res 1985;9:461–474.

  25. 25.

    Wilson JR, Reichek N, Dunkman WB, et al. Effect of diuresis on the performance of the failing, left ventricle in man.Am J Med 1981;70:234–239.

  26. 26.

    Mierzwiak DS. Acute effects of furosemide on left ventricular contractility in dogs.Arch Int Pharmacodyn 1975;213: 180–185.

  27. 27.

    Gonska BD, Kreuzer H. Diuretische monotherapie der herzinsuffizienz.Dtsch Med Wschr 1985;110:1812–1816.

  28. 28.

    Brater DC, Chennavasin P, Dehmer GJ. Prolonged hemodynamic effect of furosemide, in congestive heart failure.Am Heart J 1984:108:1031–1032.

  29. 29.

    Bayliss J, Norell M, Canepa-Anson R, et al. Untreated heart failure. Clinical and neuroendocrine effects of introducing diuretics.Br Heart J 1987;57:17–22.

  30. 30.

    Franciosa JA, Park M, Levine TB. Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure.Am J Cardiol 1981;47:33–39.

  31. 31.

    Roberts CJC, Homeida M, Roberts F. et al. Effects of piretanide, bumetanide and furosemide on electrolyte and urate excretion, in normal subjects.Br J Clin Pharmacol 1978;6:129–133.

  32. 32.

    Verho M, Rangoonwala B, Dols W, et al. Piretanide, a potassium stable diuretic, in the treatment of essential hypertension.Eur J Pharmacol 1984;27:407–411.

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Correspondence to W. Haerer M. D..

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Haerer, W., Bauer, U., Sultan, N. et al. Acute and chronic effects of a diuretic monotherapy with piretanide in congestive heart failure—A placebo-controlled trial. Cardiovasc Drug Ther 4, 515–521 (1990). https://doi.org/10.1007/BF01857763

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Key Words

  • congestive heart failure
  • diuretic monotherapy
  • hemodynamics
  • piretanide
  • placebo