Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated XXXX .

@entity177 @entity712 @entity13519
BACKGROUND: Reduction in systolic blood pressure ( @entity13519 reduction) during the treatment of acute decompensated @entity712 is strongly and independently associated with @entity177 . Our objective was to determine whether @entity13519 reduction or titration of oral neurohormonal antagonists during acute decompensated @entity712 treatment negatively influences diuresis and decongestion. METHODS AND RESULTS: @entity13519 reduction was evaluated from admission to discharge in consecutive acute decompensated @entity712 admissions (n=656). Diuresis and decongestion were examined across a range of parameters, such as diuretic efficiency, fluid output, hemoconcentration, and diuretic dose. The average reduction in @entity13519 was 14.4  19.4 mm   Hg, and 77.6% of the population had discharge @entity13519 lower than admission. @entity13519 reduction was strongly associated with @entity177 (odds ratio, 1.9; 95% confidence interval, 1.2-2.9; P=0.004), a finding that persisted after adjusting for parameters of diuresis and decongestion (odds ratio, 2.0; 95% confidence interval, 1.3-3.2; P=0.002). However, @entity13519 reduction did not negatively affect diuresis or decongestion (P>= 0.25 for all parameters). Uptitration of neurohormonal antagonists occurred in >50% of admissions and was associated with a modest additional reduction in blood pressure ( <=5.6 mm   Hg). Notably, @entity177 was not increased, and diuretic efficiency was significantly improved with the uptitration of neurohormonal antagonists. CONCLUSIONS: Despite a higher rate of @entity177 , blood pressure reduction was not associated with worsening of diuresis or decongestion. Furthermore, titration of oral neurohormonal antagonists was actually associated with improved diuresis in this cohort. These results provide reassurance that the guideline-recommended titration of chronic oral medication during acute decompensated @entity712 hospitalization may not be antagonistic to the short-term goal of decongestion.
