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The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study
BACKGROUND: Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP). METHODS: The medical records of 144 consecutive patients with HF-LBP who received gluco...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520478/ https://www.ncbi.nlm.nih.gov/pubmed/34675630 http://dx.doi.org/10.2147/IJGM.S334132 |
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author | Li, Shuyu Zhao, Qingzhen Zhen, Yuzhi Li, Lizhuo Mi, Yiqing Li, Tongxin Liu, Kunshen Liu, Chao |
author_facet | Li, Shuyu Zhao, Qingzhen Zhen, Yuzhi Li, Lizhuo Mi, Yiqing Li, Tongxin Liu, Kunshen Liu, Chao |
author_sort | Li, Shuyu |
collection | PubMed |
description | BACKGROUND: Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP). METHODS: The medical records of 144 consecutive patients with HF-LBP who received glucocorticoids as an adjunctive treatment to facilitate the up-titration of β-blocker and angiotensin-converting enzyme inhibitor were reviewed. RESULTS: After four weeks of treatment, the metoprolol and captopril (or equivalent) dosages were progressively and consistently increased from 25 (interquartile range [IQR] = 12.5–75 mg/day) to 100 mg/day (IQR = 50–178.8 mg/day) and from 0 (IQR = 0–25 mg/day) to 12.5 mg/day (IQR = 0–50 mg/day), respectively. There was a remarkable beneficial hemodynamic response to the glucocorticoid treatment signified by an increase in blood pressure and decrease in heart rate. The average heart rate decreased by 6 beat per minute (bpm) (0.5–16 bpm), and the mean arterial blood pressure increased from 74.06 ± 7.81 to 78.85 ± 7.91 mmHg. We also observed an improvement in renal function and an increased diuretic response following glucocorticoid treatment. As a result, the left ventricular ejection fraction increased from 28.92 ± 8.06% to 33.86 ± 8.76%, and the diuretic response increased from 776.7 mL/40 mg furosemide (IQR = 133.8–2000 mL) to 4000 mL/40 mg furosemide on day 28 (IQR = 2200–5925 mL). CONCLUSION: The use of glucocorticoid treatment to maintain hemodynamic and renal functional targets when titrating guideline-directed medical treatment in patients with HF-LBP may be safe, effective, and feasible. |
format | Online Article Text |
id | pubmed-8520478 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-85204782021-10-20 The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study Li, Shuyu Zhao, Qingzhen Zhen, Yuzhi Li, Lizhuo Mi, Yiqing Li, Tongxin Liu, Kunshen Liu, Chao Int J Gen Med Original Research BACKGROUND: Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP). METHODS: The medical records of 144 consecutive patients with HF-LBP who received glucocorticoids as an adjunctive treatment to facilitate the up-titration of β-blocker and angiotensin-converting enzyme inhibitor were reviewed. RESULTS: After four weeks of treatment, the metoprolol and captopril (or equivalent) dosages were progressively and consistently increased from 25 (interquartile range [IQR] = 12.5–75 mg/day) to 100 mg/day (IQR = 50–178.8 mg/day) and from 0 (IQR = 0–25 mg/day) to 12.5 mg/day (IQR = 0–50 mg/day), respectively. There was a remarkable beneficial hemodynamic response to the glucocorticoid treatment signified by an increase in blood pressure and decrease in heart rate. The average heart rate decreased by 6 beat per minute (bpm) (0.5–16 bpm), and the mean arterial blood pressure increased from 74.06 ± 7.81 to 78.85 ± 7.91 mmHg. We also observed an improvement in renal function and an increased diuretic response following glucocorticoid treatment. As a result, the left ventricular ejection fraction increased from 28.92 ± 8.06% to 33.86 ± 8.76%, and the diuretic response increased from 776.7 mL/40 mg furosemide (IQR = 133.8–2000 mL) to 4000 mL/40 mg furosemide on day 28 (IQR = 2200–5925 mL). CONCLUSION: The use of glucocorticoid treatment to maintain hemodynamic and renal functional targets when titrating guideline-directed medical treatment in patients with HF-LBP may be safe, effective, and feasible. Dove 2021-10-12 /pmc/articles/PMC8520478/ /pubmed/34675630 http://dx.doi.org/10.2147/IJGM.S334132 Text en © 2021 Li et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Li, Shuyu Zhao, Qingzhen Zhen, Yuzhi Li, Lizhuo Mi, Yiqing Li, Tongxin Liu, Kunshen Liu, Chao The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study |
title | The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study |
title_full | The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study |
title_fullStr | The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study |
title_full_unstemmed | The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study |
title_short | The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study |
title_sort | impact of glucocorticoid therapy on guideline-directed medical treatment titration in patients hospitalized for heart failure with low blood pressure: a retrospective study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520478/ https://www.ncbi.nlm.nih.gov/pubmed/34675630 http://dx.doi.org/10.2147/IJGM.S334132 |
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