Effect of hydralazine on renal failure in patients with congestive heart failure.

renal response to oral hydralazine therapy in severe heart failure. Circulation 56 (suppl III): 111-9, 1977 33. Birch AA, Boyce WH: Changing renal blood flow following sodium nitroprusside in patients undergoing nephrolithotomy. SUMMARY Hydralazine is known to improve cardiac function in patients with congestive heart failure (CHF), but its effects on renal function in CHF are less clear. Sodium retention is known to occur with long-term use of hydralazine to treat hypertension; if this occurs in patients with CHF it could be deleterious. Therefore, in a metabolic unit we studied renal effects of hydralazine in patients with stable class III or IV CHF. In a single-blind study, the patients were given placebo twice daily for 3 days (period P-1), 100 mg of oral hydralazine twice daily for 3 days (period P-H), and placebo for 3 more days (period P-2). The average 24-hour creatinine clearance was 69.7 ± 7.7 ml/min (mean i SEM) in P-1, increased to 76.3 i 9.0 ml/min with hydralazine (p < 0.01) and fell again when hydralazine was stopped (P-2) to 68.5 i 7.8 ml/min (p < 0.02). Though the slight improvement in sodium excretion was not statistically significant (60. were unchanged, as were weight and urine volume. Diastolic blood pressure, heart rate and respirations were unchanged. Thus, we found no evidence of sodium or water retention during hydralazine administration in patients with CHF, and renal function was actually improved, as evidenced by the increased creatinine clearance. HYDRALAZINE improves left ventricular performance in patients with congestive heart failure (CHF)' and may be effective for long-term oral therapy of patients with chronic CHF.1 2 However, hydralazine can lead to sodium and fluid retention when used to treat hypertension,3-5 and sodium retention has been reported during administration of hydralazine in a patient with CHF.6 Such a response to hydralazine in patients with CHF might limit the value of this drug for long-term therapy or necessitate larger doses of diuretics. The present study assesses the effects of hydralazine on renal function and sodium balance in patients with CHF. Methods Nine male patients with New York Heart Association functional class III or IV heart failure (three class IV and six class III) who were on conventional therapy were studied. The patients were ages 47-64 years (average 59 years). Three of the patients had primary myocardial disease and six had ischemic heart disease. Exclusion criteria included: insulin-dependent diabetes mellitus, severe pulmonary disease …