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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/19830

Title: Response and tolerance to oral vasodilator up-titration after intravenous vasodilator therapy in advanced decompensated heart failure
Authors: Verbrugge, Frederik H.
Dupont, Matthias
Finucan, Michael
Gabi, Alaa
Hawwa, Noel
Mullens, Wilfried
Taylor, David O.
Young, James B.
Starling, Randall C.
Tang, W. H. Wilson
Issue Date: 2015
Publisher: WILEY-BLACKWELL
Citation: EUROPEAN JOURNAL OF HEART FAILURE, 17 (9), p. 956-963
Abstract: Aims The aim of this study was to assess the haemodynamic response and tolerance to aggressive oral hydralazine/isosorbide dinitrate (HYD/ISDN) up-titration after intravenous vasodilator therapy in advanced decompensated heart failure (ADHF). Methods and results Medical records of 147 consecutive ADHF patients who underwent placement of a pulmonary artery catheter and received intravenous vasodilator therapy were reviewed. Intravenous sodium nitroprusside and sodium nitroglycerin as first-line agent for those with preserved blood pressures were utilized in 143 and 32 patients, respectively. Sixty-one percent of patients were converted to oral HYD/ISDN combination therapy through a standardized conversion protocol. These patients had a significantly higher admission mean pulmonary arterial wedge pressure compared with patients not converted (28 +/- 7 vs. 25 +/- 8 mmHg, respectively; P-value 0.024). Beneficial haemodynamic response to decongestive therapy, defined as low cardiac filling pressures and cardiac index >= 2.20 L/min/m(2) without emergent hypotension, was achieved in 32% and 29% of patients who did or did not receive oral HYD/ISDN, respectively (P-value 0.762). HYD/ISDN dosing was progressively and consistently decreased up to the moment of hospital discharge and during outpatient follow-up, primarily due to incident hypotension. Conclusion The use of a standardized haemodynamically guided up-titration protocol for conversion from intravenous to oral vasodilators may warrant subsequent dose reductions upon stabilization.
Notes: [Verbrugge, Frederik H.; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. [Verbrugge, Frederik H.; Mullens, Wilfried] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Verbrugge, Frederik H.; Finucan, Michael; Gabi, Alaa; Hawwa, Noel; Taylor, David O.; Young, James B.; Starling, Randall C.; Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH USA.
URI: http://hdl.handle.net/1942/19830
DOI: 10.1002/ejhf.324
ISI #: 000363046600013
ISSN: 1388-9842
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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