Abstract
Many of the primary clinical manifestations of heart failure are due to fluid retention and congestion, and therefore treatments targeting congestion play a central role in heart failure management. Diuretic therapy remains the cornerstone of congestion treatment, and diuretics are prescribed to the majority of heart failure patients. Despite this ubiquitous use, there is limited evidence from prospective randomized studies to guide the use of diuretics. Some observational data have suggested that diuretics may actually be harmful in heart failure, potentially contributing to worsening renal function, neurohormonal activation, and even heart failure progression. Recent clinical trial data have provided new insights into the balance of risks and benefits from diuretics. This review describes the mechanism of action of available diuretic classes, reviews their clinical use based on current guidelines, and briefly discusses evolving alternatives to diuretic therapy in the management of congestion in heart failure patients.
References
Nov 1, 1990·Circulation·G S FrancisS Yusuf
Oct 1, 1989·Kidney International·N R LoonR J Unwin
Jul 1, 1985·Annals of Internal Medicine·G S FrancisJ N Cohn
Sep 2, 1999·The New England Journal of Medicine·B PittJ Wittes
Sep 24, 1999·Circulation·H A CooperM J Domanski
Jan 24, 2002·Cardiology·D H Ellison
Mar 20, 2002·Circulation·Stephen S GottliebWilliam T Abraham
Feb 5, 2004·American Heart Journal·Javed ButlerHarlan M Krumholz
Jun 11, 2004·Journal of Cardiac Failure·Monica R Shah, Lynne W Stevenson
Aug 6, 2004·The New England Journal of Medicine·David N JuurlinkDonald A Redelmeier
Sep 15, 2004·Journal of the American College of Cardiology·John M McCurleyMark C Haigney
Feb 28, 2006·Journal of Cardiac Failure· Heart Failure Society Of America
Feb 28, 2006·Journal of Cardiac Failure·UNKNOWN Heart Failure Society Of America
May 20, 2006·European Heart Journal·Ali AhmedRobert C Bourge
Feb 13, 2007·Journal of the American College of Cardiology·Maria Rosa CostanzoUNKNOWN UNLOAD Trial Investigators
Mar 27, 2007·JAMA : the Journal of the American Medical Association·Marvin A KonstamUNKNOWN Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators
Mar 27, 2007·JAMA : the Journal of the American Medical Association·Mihai GheorghiadeUNKNOWN Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators
Jun 2, 2007·American Heart Journal·Gregg C FonarowUNKNOWN ADHERE Scientific Advisory Committee and Investigators
Aug 28, 2007·European Journal of Heart Failure·Vic HasselbladKirkwood F Adams
Sep 19, 2008·European Heart Journal·Kenneth DicksteinUNKNOWN ESC Committee for Practice Guidelines (CPG)
Oct 18, 2008·Journal of Cardiac Failure·Gad CotterUNKNOWN Protect Steering Committee, Investigators, and Coordinators
Dec 17, 2008·Circulation·Donald Lloyd-JonesUNKNOWN American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Mar 28, 2009·Circulation·Mariell JessupClyde W Yancy
Sep 15, 2009·Circulation. Heart Failure·G Michael FelkerUNKNOWN Heart Failure Clinical Research Network Investigators
Citations
Jun 1, 2014·Journal of Cardiac Failure·Zachary L Cox, Daniel J Lenihan
Sep 22, 2011·Expert Review of Cardiovascular Therapy·Michael J BoniosJohn N Nanas
Jan 23, 2016·Clinical Kidney Journal·Baris AfsarMehmet Kanbay
Dec 18, 2013·Journal of Critical Care·Mei-Yi WuKa-Wai Tam
Sep 24, 2013·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Sabine ReclaDietmar Schranz
Dec 7, 2010·European Journal of Heart Failure·Cristina GiglioliSalvatore Mario Romano
Dec 7, 2014·Expert Opinion on Pharmacotherapy·Elisabeth KaldaraJohn N Nanas
Jun 9, 2012·Journal of the American College of Cardiology·G Michael Felker, Robert J Mentz
Jun 17, 2014·Journal of Ethnopharmacology·Zhen-Li WuDing-Li Xu
Mar 1, 2017·Current Heart Failure Reports·E Ashley Hardin, Justin L Grodin
Apr 9, 2014·Journal of Cardiovascular Pharmacology·Chao LiuUNKNOWN COPE-ADHF Study Group
May 10, 2013·Journal of Cardiovascular Medicine·Francesco GiallauriaUNKNOWN ISYDE-2008 Investigators of the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR)
Aug 24, 2017·Critical Care Nursing Quarterly·Brent N Reed, Sandeep Devabhakthuni
Sep 13, 2017·PloS One·Mei-Yi WuYu-Kang Tu
Aug 23, 2019·Journal of Evaluation in Clinical Practice·Nourin Ali SherifNguyen Tien Huy
Jun 17, 2020·Cardiovascular Endocrinology & Metabolism·Ertan YetkinSelcuk Ozturk
Oct 31, 2019·BMC Cancer·Peipei LiuChris R Cardwell
May 9, 2014·International Heart Journal·Teruhiko ImamuraIssei Komuro
May 27, 2011·The New England Journal of Medicine·Paul G Jenkins