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

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Abstract
Hydralazine improves cardiac function in patients with congestive heart failure (CHF), but its effects on renal function in CHF are less clear. Na retention occurs with long-term use of hydralazine to treat hypertension; if this occurs in patients with CHF it could be deleterious. In a metabolic unit renal effects of hydralazine in patients with stable class III or IV CHF were studied. 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 h creatinine clearance was 69.7 .+-. 7.7 ml/min (mean .+-. SEM, SE of mean) in P-1, increased to 76.3 .+-. 9.0 ml/min with hydralazine (P < 0.01) and fell again when hydralazine was stopped (P-2) to 68.5 .+-. 7.8 ml/min (P < 0.02). Though the slight improvement in Na excretion was not statistically significant (60.2 .+-. 12.1 meq in P-1, 64.5 .+-. 12.4 meq in P-H, 52.3 .+-. 7.7 meq in P-2), serum osmolality decreased from 288 .+-. 1.8 mosM [milli osmolar] in P-1 to 283 .+-. 1.0 mosM in P-H (P < 0.02) and rose to 286 .+-. 1.9 mosM in P-2 (NS [not significant]). During the 3 periods, serum Na, Cl, K, CO2, blood urea nitrogen, creatinine, glucose weight and urine volume were unchanged. Systolic blood pressure was 109.6 .+-. 3.6 mm Hg in P-1, 110.1 .+-. 3.9 mm Hg in P-H (NS) and 114.2 .+-. 5.0 mm Hg in P-2 (P < 0.05). Diastolic blood pressure, heart rate and respirations were unchanged. No evidence of Na or water retention was found during hydralazine administration in patients with CHF, and renal function wasactually improved, as evidenced by the increased creatinine clearance.