The effects of short-term omission of daily medication on the pathophysiology of heart failure

S. Dovancescu, P. Pellicori, T. Mabote, A. Torabi, A.L. Clark, J.G.F. Cleland

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aims: Pharmacological therapies for heart failure (HF) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening HF. Characterizing the effects of short-term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening HF. We examined the effect of planned HF medication omission for 48 h on weight, echocardiograms, transthoracic bio-impedance, and plasma concentrations of NT-proBNP. Methods and results: Outpatients with stable HF and an LVEF <45% were assigned to take or omit their HF medication for 48 h in a randomized, crossover trial. Twenty patients (16 men, LVEF 32 ± 9%, median NT-proBNP 962 ng/L) were included. Compared with regular medication, omission led to an increase in NT-proBNP by 99% (from 962 to 1883 ng/L, P < 0.001), systolic blood pressure by 16% (from 131 to 152 mmHg, P < 0.001), and left atrial volume by 21% (from 69 to 80 mL, P = 0.001), and reductions in transthoracic bio-impedance by 10% (from 33 to 30 Σ, P = 0.001) and serum creatinine by 8% (from 135 to 118 µmol/L, P = 0.012). No significant changes in body weight, heart rate, or LVEF were observed. Conclusions: The characteristic pattern of response to short-term medication omission is of increasing congestion but, in contrast to the pattern reported for disease progression, with a rise in blood pressure and improved renal function. In stable HF, weight is not a sensitive marker of short-term diuretic omission.

Original languageEnglish
Pages (from-to)643-649
Number of pages7
JournalEuropean Journal of Heart Failure
Volume19
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • Cardiac ultrasound
  • Congestion
  • Heart failure
  • Medication omission
  • Telemonitoring
  • Transthoracic bio-impedance
  • Angiotensin-Converting Enzyme Inhibitors/therapeutic use
  • Prognosis
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Male
  • Adrenergic beta-Antagonists/therapeutic use
  • Heart Failure/blood
  • Stroke Volume/drug effects
  • Time Factors
  • Biomarkers/blood
  • Female
  • Heart Rate
  • Echocardiography
  • Diuretics/therapeutic use
  • Mineralocorticoid Receptor Antagonists/therapeutic use
  • Creatinine/blood
  • Electric Impedance
  • Disease Progression
  • Cross-Over Studies
  • Outpatients
  • Blood Pressure/drug effects
  • Aged
  • Patient Compliance/statistics & numerical data
  • Peptide Fragments/blood
  • Blood Pressure Monitoring, Ambulatory
  • Natriuretic Peptide, Brain/blood

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