Renal Response to Captopril in Severe Heart Failure: Role of Furosemide in Natriuresis and Reversal of Hyponatremia

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Abstract
To assess the effect of furosemide and captopril on renal function and hyponatremia in patients with severe heart failure, 2 groups of patients with hyponatremia who were receiving digoxin therapy and whose Na intake was 40 meq/d [day] were studied. One group received captopril and furosemide, the second received captopril. The first group responded to combination therapy with a brisk natriuresis and diuresis, weight reduction and an increase in serum Na concentration. Patients who received captopril alone did not respond, despite a similar increase in renal plasma flow and glomerular filtration rate. When furosemide was then administered to patients who had received captopril alone, a brisk natriuresis, weight loss and correction of hyponatremia followed. Treatment with furosemide is necessary to promote natriuresis and correction of hyponatremia in patients with severe heart failure treated with captopril; the renal vascular action of captopril enhances the effectiveness of furosemide.