Maternal Hemodynamic Changes Associated with Furosemide Treatment

Carr, Darcy B.; Gavrilă, Daniel; Brateng, Debra; Easterling, Thomas R.

doi:10.1080/10641950701204489

Cited by 30 publications

(26 citation statements)

References 9 publications

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“…3 The SLV320 data as well as other studies 14,15,19 -22 suggest that a blockade of the A1 receptor might be of special interest in several subgroups of patients with HF: (1) patients with diuretic resistance; (2) patients with acutely decompensated HF with worsening of GFR; (3) patients with chronic HF requiring long-term treatment with diuretics; and (4) patients with HF with a pronounced cardiac remodelling or fibrosis. 17,18 With respect to acutely decompensated HF, it is important that SLV320 did not alter total peripheral resistance, whereas furosemide treatment is known to increase total peripheral resistance 37,38 as shown in the study. Increase of total peripheral resistance in patients with an acutely failing heart is clearly an adverse effect of loop diuretics.…”

Section: Discussionmentioning

confidence: 68%

Cardio-Renal Effects of the A1 Adenosine Receptor Antagonist SLV320 in Patients With Heart Failure

Mitrović

Seferović

Dodić

et al. 2009

Circ: Heart Failure

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Background-Blocking the tubuloglomerular feedback mechanism with adenosine A1 receptor antagonists seems to improve diuresis and sodium excretion without compromising the glomerular filtration rate in patients with heart failure. However, the direct cardiac effects of this compound class have not been investigated to date. Methods and Results-In total, 111 patients (109 men and 2 women) received a 1-hour infusion of 5, 10, and 15 mg SLV320, an adenosine A1 receptor antagonist, placebo, or 40 mg furosemide. Mean age was 57.9 years, mean ejection fraction was 28.1%, 82 patients were of New York Heart Association class II, and 29 patients were of New York Heart Association class III. Hemodynamic parameters (heart rate, blood pressure, pulmonary capillary wedge pressure, mean pulmonary arterial pressure, systemic vascular resistance, right atrial pressure, and cardiac output) were determined. Kidney function was assessed by cystatin C measurements and by analysis of urine output and urine electrolytes. In addition, pharmacokinetics of SLV320 and ex vivo inhibition of adenosine A1 receptor activity were performed. SLV320 was well tolerated, and no serious adverse events were observed. Heart rate, blood pressure, pulmonary capillary wedge pressure, mean pulmonary arterial pressure, right atrial pressure, and cardiac output were not altered by any dose of SLV320. Pulmonary capillary wedge pressure was significantly (Pϭ0.04) decreased by furosemide (Ϫ6.2Ϯ5.9 mm Hg). Systemic vascular resistance was significantly (Pϭ0.04) increased in the furosemide group (ϩ166.70Ϯ261.87 dynes ⅐ s Ϫ1 ⅐ cm

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Section: Discussionmentioning

confidence: 68%

Cardio-Renal Effects of the A1 Adenosine Receptor Antagonist SLV320 in Patients With Heart Failure

Mitrović

Seferović

Dodić

et al. 2009

Circ: Heart Failure

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“…In Figure 1, the vector labeled “furosemide” demonstrates the hemodynamic changes observed in 21 hypertensive pregnant women with elevated cardiac output treated with oral furosemide. 18 The observed vector of change demonstrates a reduction in cardiac output but with a more marked deviation towards a higher resistance when compared to the atenolol vector. Treatment did not change mean arterial pressure, but reduced stroke volume (−17 mL – 12%) and cardiac output (−1.2 L/min – 12%).…”

Section: Pharmacodynamics Of Antihypertensive Agents In Pregnancymentioning

confidence: 86%

“…Treatment did not change mean arterial pressure, but reduced stroke volume (−17 mL – 12%) and cardiac output (−1.2 L/min – 12%). 18 Vascular resistance increased 101 dyne•sec•cm −5 (+14%), probably representing a compensatory response to maintain an elevated blood pressure. 18 Similar data does not exist for hydrochlorothiazide.…”

Section: Pharmacodynamics Of Antihypertensive Agents In Pregnancymentioning

confidence: 99%

“…18 Vascular resistance increased 101 dyne•sec•cm −5 (+14%), probably representing a compensatory response to maintain an elevated blood pressure. 18 Similar data does not exist for hydrochlorothiazide. To the extent that the assumed mechanism of action is true, diuresis, we would expect similar vectors of action.…”

Section: Pharmacodynamics Of Antihypertensive Agents In Pregnancymentioning

confidence: 99%

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Pharmacological management of hypertension in pregnancy

Easterling

2014

Seminars in Perinatology

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Hypertension in pregnancy remains a significant public health problem. Pharmacological management of blood pressure in pregnancy is impacted by changes in maternal drug disposition and by the pharmacodynamic effects of specific agents. This paper will review the impact of pregnancy on pathways of drug elimination and the associated clinical implications, the pharmacodynamic effects of specific drugs and classes of drugs in pregnancy, and the data to date on the impact of antihypertensive therapy on mothers and their fetuses.

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“…), abstinence from application during pregnancy has long been advocated because of the observed increase of peripheral resistance in a group of pregnant women with chronic hypertension (Carr et al . ). The lack of terotogenic or clinical neonatal side effects in pregnancies with maintenance of chronic diuretic treatment or with acute cardiac or nephrological problems (von Dadelszen et al .…”

Section: Common Clinical Characteristics Of Cardiorenal Syndromes Andmentioning

confidence: 97%

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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Maternal Hemodynamic Changes Associated with Furosemide Treatment

Abstract: While furosemide improved the hyperdynamic circulation in pregnancy, it did not lower blood pressure or cause clinically significant vasoconstriction.

Cited by 30 publications

References 9 publications

Cardio-Renal Effects of the A1 Adenosine Receptor Antagonist SLV320 in Patients With Heart Failure

Cardio-Renal Effects of the A1 Adenosine Receptor Antagonist SLV320 in Patients With Heart Failure

Pharmacological management of hypertension in pregnancy

Preeclampsia: a gestational cardiorenal syndrome

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