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Low-dose furosemide administered with adequate hydration reduces contrast-induced nephropathy in patients undergoing coronary angiography.
Gu, GQ, Lu, R, Cui, W, Liu, F, Zhang, Y, Yang, XH, Chen, XF, Jia, WM
Cardiology. 2013;(2):69-73
Abstract
OBJECTIVE We investigated the effects of low-dose furosemide, administered with adequate hydration on contrast-induced nephropathy (CIN). METHODS A total of 859 patients scheduled to undergo coronary angiography or angioplasty were enrolled and randomly assigned to a furosemide treatment or control group. All patients received supplemental hydration. Immediately after surgery, patients in the furosemide group received intravenous furosemide injection (20 mg); those in the control group received no treatment. Total fluid intake and urine output were recorded. Pre- and postsurgical changes in serum creatinine levels (SCr), glomerular filtration rate (GFR) and creatinine clearance rate (CCr) were assessed, and the incidence of CIN was also evaluated between the two groups. Logistic regression analysis was used to study risk factors for CIN. RESULTS General baseline conditions were similar between the two groups. Patients who received furosemide had significantly less increase in SCr and a more marked increase in GFR and CCr than those who did not. The incidence of CIN was significantly higher in the control group. Logistic regression analysis revealed that female gender and angiotensin-converting enzyme inhibitor were risk factors for CIN, whereas furosemide acted as a protective agent. CONCLUSIONS With full hydration, small doses of furosemide can reduce CIN better than hydration alone.
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The independent impact of congestive heart failure status and diuretic use on serum uric acid among men with a high cardiovascular risk profile: a prospective longitudinal study.
Misra, D, Zhu, Y, Zhang, Y, Choi, HK
Seminars in arthritis and rheumatism. 2011;(3):471-6
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Abstract
OBJECTIVE To evaluate the independent impact of congestive heart failure (CHF) status (compensation or decompensation) on serum uric acid levels among men with high cardiovascular risk profile. METHOD We analyzed 11,681 men from the Multiple Risk Factor Interventional Trial, using data prospectively collected at baseline and annually over 6 years (64,644 visits). We evaluated the impact of change in CHF status during study follow-up, as compared with study baseline, on hyperuricemia (serum uric acid ≥7 mg/dL) and serum uric acid levels, using generalized estimating equations, adjusting for age, race, weight, weight change, education, alcohol intake, diuretic use, hypertension, serum creatinine level, and dietary factors. Similarly, we evaluated the independent impact of change in diuretic use (initiation or discontinuation). RESULTS At baseline, mean serum uric acid was 6.88 mg/dL. Compared with no change in CHF status, odds ratios of hyperuricemia were 1.67 (95% CI, 1.21 to 2.32) for CHF decompensation and 0.21 (95% CI, 0.08 to 0.55) for compensation. The corresponding uric acid differences were 0.41 (95% CI, 0.20 to 0.62) and -1.00 (95% CI, -1.72 to -0.27), respectively. The odds ratios for initiation and discontinuation of diuretic were 3.32 (95% CI, 3.06 to 3.61) and 0.39 (95% CI, 0.35 to 0.44). CONCLUSIONS CHF decompensation and diuretic use are both independently associated with increased odds of hyperuricemia among men with a high cardiovascular risk profile, whereas CHF recovery and diuretic discontinuation are associated with substantially lower odds of hyperuricemia.
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Fixed-combination of amlodipine and diuretic chronotherapy in the treatment of essential hypertension: improved blood pressure control with bedtime dosing-a multicenter, open-label randomized study.
Zeng, J, Jia, M, Ran, H, Tang, H, Zhang, Y, Zhang, J, Wang, X, Wang, H, Yang, C, Zeng, C
Hypertension research : official journal of the Japanese Society of Hypertension. 2011;(6):767-72
Abstract
Previous studies have demonstrated that individual anti-hypertension medications have different effects when administered in the morning vs. the evening. However, the impact of administration timing on fixed combinations of anti-hypertensive medications on blood pressure control is still unknown. In the present study, we examined the administration time-dependent effects of a fixed combination of amlodipine and diuretics (amlodipine complex) on blood pressure in hypertensive subjects. Eighty patients from Chongqing City were enrolled in this study. Subjects were randomly assigned to receive a single pill (amlodipine complex, each tablet containing amlodipine 5 mg and hydrochlorothiazide 25 mg), either in the morning (0800 hours, n=40) or at bedtime (2200 hours, n=40). Blood pressure was measured by ambulatory monitoring every 20 min during the day and every 30 min at night for 24 consecutive hours before and after the 12 weeks of treatment. Following treatment, the 24-h mean systolic and diastolic blood pressures were reduced significantly in both the morning and bedtime groups. However, the morning blood pressure surge was reduced to a greater degree in the bedtime group. In addition, the nocturnal blood pressure and the 24 h mean blood pressure were lower in the bedtime group. More patients converted from having a non-dipper to dipper blood pressure in the bedtime group. These findings confirm that amlodipine complexes have different efficiencies depending on treatment time. Administration of amlodipine complexes at bedtime could optimize the anti-hypertensive effect by augmenting blood pressure-lowering effects, increasing the diurnal/nocturnal ratio of blood pressure, normalizing the blood pressure pattern and minimizing the morning blood pressure surge.
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The combination of amlodipine and angiotensin receptor blocker or diuretics in high-risk hypertensive patients: rationale, design and baseline characteristics.
Wang, W, Ma, L, Zhang, Y, Deng, Q, Liu, M, Liu, L
Journal of human hypertension. 2011;(4):271-7
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Abstract
The Chinese Hypertension Intervention Efficacy Study (CHIEF) is a multi-centre randomized controlled clinical trial comparing the effects of amlodipine+angiotensin II receptor blocker and amlodipine+diuretics on the incidence of cardiovascular events, represented as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death events in high-risk Chinese hypertensive patients. The study also evaluates the long-term effects of lipid-lowering treatment and lifestyle modification. From October 2007 to October 2008, 13,542 patients were enrolled into the study in 180 centres in China. Patients will be followed up for 4 years. There was no difference in baseline characteristics between the two blood pressure arms.