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diuretic titration

Md Shahidul Islam
It is important to understand the rationale for appropriate use of different diuretics, alone or in combination, in different heart failure patients, under diverse clinical settings. Clinicians and nurses engaged in heart failure care, must be familiar with different diuretics, their appropriate doses, methods of administration, monitoring of the responses, and the side-effects. Inappropriate use of diuretics, both under-treatment and overtreatment, and poor follow-up can lead to failures, and adverse outcomes...
March 3, 2018: Advances in Experimental Medicine and Biology
Elizabeth K Pogge, Lindsay E Davis
OBJECTIVE: The objective of this research was to describe the use of pharmacist-managed sacubitril/valsartan therapy in a multi-center, outpatient cardiac group. BACKGROUND: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi), is a novel agent for the treatment of heart failure. An ARNi is recommended by national guidelines to be used in place of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy for patients who remain symptomatic...
February 17, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Shih-Hung Hsiao, Shih-Kai Lin, Yi-Ran Chiou, Chin-Chang Cheng, Hwong-Ru Hwang, Kuan-Rau Chiou
BACKGROUND: Titration of evidence-based medications, important for treating heart failure (HF), is often underdosed by symptom-guided treatment. The aim of this study was to investigate, using echocardiographic parameters, stroke volume and left ventricular (LV) filling pressure to guide up-titration of medications, increasing prognostic benefits. METHODS: A total of 765 patients with chronic HF and severely reduced LV ejection fractions (<35%), referred from 2008 to 2016, were prospectively studied...
February 6, 2018: Journal of the American Society of Echocardiography
David Pham, Justin L Grodin
Despite advances in medical therapy over the past few decades, the incidence of heart failure hospitalisation continues to rise. Diuretics are the most common therapy used to treat heart failure as they relieve congestion. However, there is a lack of guidance on how to best use these medications. Guidelines support the use of diuretics at the lowest clinically effective dose but do not specify a diuretic strategy beyond that. Here we review the diuretics available for treatment, potential mechanisms of diuretic resistance and ways to address this in the ambulatory setting, and review tools that have been developed to help guide diuretic use in the treatment of chronic heart failure...
November 2017: Cardiac Failure Review
Christoph Klivinyi, Helmar Bornemann-Cimenti
Long QT syndrome is a cardiac repolarization disorder and is associated with an increased risk of torsades de pointes. The acquired form is most often attributable to administration of specific medications and/or electrolyte imbalance. This review provides insights into the risk for QT prolongation associated with drugs frequently used in the treatment of chronic pain. In the field of pain medicine all the major drug classes (i.e. NSAIDs, opioids, anticonvulsive and antidepressant drugs, cannabinoids, muscle relaxants) contain agents that increase the risk of QT prolongation...
January 2018: Korean Journal of Pain
Venu Gopal Jonnalagadda, Kanchan Choudhary, Vijay Kranti Matety
We have read the article "Comparison of effects between calcium channel blocker and diuretics in combination with angiotensin II receptor blocker on 24-h central blood pressure and vascular hemodynamic parameters in hypertensive patients: study design for a multicenter, double-blinded, active controlled, phase 4, randomized trial" by GC Oh., et al. and found it quite interesting to learn the testing of effectiveness between amlodipine and hydrochlorothiazide in combination with losartan. After 4 weeks of therapy, non-responders were exposed for dose titration of losartan/amlodipine 100/5 mg daily or losartan/hydrochlorothiazide 100/25 mg daily...
2017: Clinical Hypertension
Sabrina M Hormann, Lindsay E Davis, Elizabeth K Pogge
BACKGROUND: Heart failure prevalence continues to rise in the United States causing significant morbidity and mortality and costing billions in healthcare expenditures. Consensus guidelines updated in 2016 recommend an angiotensin receptor-neprilysin inhibitor (ARNi) as a therapeutic option in lieu of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for the management of stage C heart failure with reduced ejection fraction (HFrEF). For chronic HFrEF patients with New York Heart Association class II or III symptoms tolerating an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, a change in therapy to an ARNi is recommended to further reduce morbidity and mortality...
March 2018: Journal of Cardiovascular Nursing
Ali A Rizvi
Hypertension is considered a powerful cardiovascular risk factor and is present in up to two-thirds of patients who suffer from diabetes. In the background of an established epidemiological association between lower blood pressure (BP) and improvement in long-term clinical outcomes, several large landmark trials and analyses have attempted to examine the possible benefit of tighter BP control in patients with Type 2 diabetes mellitus. Although aggressive BP targets in patients with diabetes have been advocated for a long time, currently accepted evidence from these studies has led to a general recommendation of systolic BP <140 mmHg and diastolic BP <90 mmHg...
October 2017: European Medical Journal. Diabetes
Milos Brankovic, K Martijn Akkerhuis, Nick van Boven, Olivier Manintveld, Tjeerd Germans, Jasper Brugts, Kadir Caliskan, Victor Umans, Alina Constantinescu, Isabella Kardys
We determined the temporal effects of neurohormonal antagonists and loop diuretics on serially assessed (3-monthly) cardiorenal biomarkers, functional status, and clinical outcomes in 250 patients with chronic heart failure (CHF) with reduced ejection fraction. In blood, we measured NT-proBNP, troponin T, C-reactive protein, creatinine, cystatin C; in urine, N-acetyl-beta-d-glucosaminidase and kidney-injury-molecule-1. Angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) were inversely associated with cardiac impairment, inflammation, and renal tubular damage, but not with glomerular dysfunction...
November 6, 2017: Clinical Pharmacology and Therapeutics
Pieter Martens, Frederik H Verbrugge, Levinia Boonen, Petra Nijst, Matthias Dupont, Wilfried Mullens
AIMS: Guidelines advocate down-titration of loop diuretics in chronic heart failure (CHF) when patients have no signs of volume overload. Limited data are available on the expected success rate of this practice or how routine diagnostic tests might help steering this process. METHODS AND RESULTS: Fifty ambulatory CHF-patients on stable neurohumoral blocker/diuretic therapy for at least 3months without any clinical sign of volume overload were prospectively included to undergo loop diuretic down-titration...
January 1, 2018: International Journal of Cardiology
João Pedro Ferreira, Tahar Chouihed, Pierre Naseyrollas, Bruno Levy, Marie F Seronde, Pascal Bilbault, François Braun, Gérald Roul, David Kénizou, Noura Zannad, Nicolas Girerd, Patrick Rossignol
Worsening renal function (i.e. any increase in creatinine or decrease in the estimated glomerular filtration rate) is common in patients admitted for acute heart failure in the emergency department. Although worsening renal function (WRF) has been associated with the occurrence of dismal outcomes, this only appears to be the case when associated with clinical deterioration. However, if the clinical status of the patient is improving, a certain increase in serum creatinine may be acceptable. This WRF, which is not associated with clinical deterioration or adverse outcomes (e...
October 3, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Frederik H Verbrugge, Pieter Martens, Levinia Boonen, Petra Nijst, David Verhaert, Patrick Noyens, Philip De Vusser, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
BACKGROUND: This study investigates spot urinary chloride concentration in euvolemic chronic heart failure (CHF) patients. METHODS: This prospective cohort study included 50 ambulatory CHF patients on maintenance loop diuretics without recent hospital admission, clinical signs of volume overload, or adjustment in neurohumoral blocker or diuretic therapy. Spot urinary samples were collected immediately after loop diuretic intake. Subsequently, loop diuretic dose was reduced with 50% or stopped if ≤40 mg furosemide equivalents...
October 3, 2017: Acta Cardiologica
Madhavan Seshadri, Madhusudan Deepak Thalitaya, Tuno Simon, Catherine Odelola, Humphrey Enow
Antidepressants are routinely used by General Practitioners (GP) as well as Psychiatrists to treat Depression. They are tolerated well. However, in certain patient populations, they are associated with SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone Secretion) and Hyponatremia. Various research studies have shown that all antidepressants are associated with Hyponatremia. Hyponatremia as a side effect of antidepressant therapy is more commonly seen in old age, chronic Kidney disease and Hypothyroidism...
September 2017: Psychiatria Danubina
Sherry K Milfred-LaForest, Julie A Gee, Adam M Pugacz, Ileana L Piña, Danielle M Hoover, Robert C Wenzell, Aubrey Felton, Eric Guttenberg, Jose Ortiz
OBJECTIVE: To perform a pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients. BACKGROUND: Transitions of care in HF should include: medication reconciliation, multidisciplinary care, early post-discharge follow-up, and prompt intervention on HF signs and symptoms. We hypothesized that combining these elements with optimization of medications would impact outcomes. METHODS: In the SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC), patients were seen by a clinical pharmacist trained in HF...
September 2017: Progress in Cardiovascular Diseases
Susan E Shoaf, Patricia Bricmont, Ann Dandurand
PURPOSE: Tolvaptan (TLV) is indicated to treat hyponatremia due to syndrome of inappropriate diuretic hormone (SIADH) in Europe. Treatment is to be initiated at 15 mg QD but post-approval reporting indicates increasing use of 7.5 mg as the starting dose. Physicians believe 7.5 mg is effective and has a lower incidence of overly rapid correction of serum sodium. METHODS: Single TLV doses of 3.75, 7.5, and 15 mg were administered to 14 healthy adults in a crossover design and to 29 subjects ≥18 years with SIADH and serum sodium between 120 and 133 mmol/L in a parallel-group design...
November 2017: European Journal of Clinical Pharmacology
Vasileios I Sakalis, Markos Karavitakis, Dina Bedretdinova, Thorsten Bach, J L H Ruud Bosch, Mauro Gacci, Christian Gratzke, Thomas R Herrmann, Stephan Madersbacher, Charalampos Mamoulakis, Kari A O Tikkinen, Stavros Gravas, Marcus J Drake
CONTEXT: The treatment of nocturia is a key challenge due to the multi-factorial pathophysiology of the symptom and the disparate outcome measures used in research. OBJECTIVE: To assess and compare available therapy options for nocturia, in terms of symptom severity and quality of life. EVIDENCE ACQUISITION: Medical databases (Embase, Medline, Cochrane Systematic Reviews, Cochrane Central) were searched with no date restriction. Comparative studies were included which studied adult men with nocturia as the primary presentation and lower urinary tract symptoms including nocturia or nocturnal polyuria...
November 2017: European Urology
Pascale Khairallah, Tamara Isakova, John Asplin, Lee Hamm, Mirela Dobre, Mahboob Rahman, Kumar Sharma, Mary Leonard, Edgar Miller, Bernard Jaar, Carolyn Brecklin, Wei Yang, Xue Wang, Harold Feldman, Myles Wolf, Julia J Scialla
BACKGROUND: The kidneys maintain acid-base homeostasis through excretion of acid as either ammonium or as titratable acids that primarily use phosphate as a buffer. In chronic kidney disease (CKD), ammoniagenesis is impaired, promoting metabolic acidosis. Metabolic acidosis stimulates phosphaturic hormones, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) in vitro, possibly to increase urine titratable acid buffers, but this has not been confirmed in humans. We hypothesized that higher acid load and acidosis would associate with altered phosphorus homeostasis, including higher urinary phosphorus excretion and serum PTH and FGF-23...
October 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Athanasios Tsiouris, Lynn Wilson, Ala S Haddadin, James J Yun, Abeel A Mangi
OBJECTIVE: The aim of this study was to analyze risk factors and outcomes of vasoplegia after cardiac surgery based on our experience with almost 2000 cardiac operations performed at our institution. METHODS: We retrospectively analyzed patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) between 2011 and 2013. Data were available for a total of 1992 patients. We defined vasoplegia as hypotension with persistently low systemic vascular resistance (<800 dyn/s/cm) and preserved Cardiac Index (>2...
October 2017: General Thoracic and Cardiovascular Surgery
Gerasimos Filippatos, Aldo P Maggioni, Carolyn S P Lam, Elisabeth Pieske-Kraigher, Javed Butler, John Spertus, Piotr Ponikowski, Sanjiv J Shah, Scott D Solomon, Andrea-Viviana Scalise, Katharina Mueller, Lothar Roessig, Luke Bamber, Mihai Gheorghiade, Burkert Pieske
AIMS: Exploratory assessment of the potential benefits of the novel soluble guanylate cyclase stimulator vericiguat on health status in patients with heart failure (HF) with preserved ejection fraction. METHODS AND RESULTS: The SOCRATES-PRESERVED trial randomized patients with chronic HF and ejection fraction ≥ 45% within 4 weeks of decompensation to 12 weeks of treatment with titrated doses of vericiguat (1.25, 2.5, 5, and 10 mg once daily) or placebo. Health status was assessed with the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) and the generic health-related quality of life measure EQ-5D...
June 2017: European Journal of Heart Failure
M Joannidis, W Druml, L G Forni, A B J Groeneveld, P M Honore, E Hoste, M Ostermann, H M Oudemans-van Straaten, M Schetz
BACKGROUND: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. OBJECTIVES: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. METHOD: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI...
June 2017: Intensive Care Medicine
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