Congestive heart failure diuretics: Difference between revisions
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* [[Eplerenone]] is more specific for [[aldosterone blockade]] and, therefore, causes less [[gynaecomastia]]. | * [[Eplerenone]] is more specific for [[aldosterone blockade]] and, therefore, causes less [[gynaecomastia]]. | ||
*In [[patients]] with impaired [[renal function]] and in those with serum [[potassium]] concentrations >5.0 mmol/L, [[MRA]] should be used with causion. | *In [[patients]] with impaired [[renal function]] and in those with serum [[potassium]] concentrations >5.0 mmol/L, [[MRA]] should be used with causion. | ||
==References== | ==References== | ||
Revision as of 14:55, 2 March 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Diuretics reduce circulating volume, improve symptoms and are a mainstay of therapy for congestive heart failure. While these agents improve symptoms, they have not been associated with a reduction in mortality and are associated with electrolyte imbalances.
Diuretics
Diuretics
- Loop diuretics is recommended to reduce the signs and/or symptoms of congestion in patients with HFrEF.[1]
- The effects of diuretics on morbidity and mortality have not been studied in RCTs.
- Loop diuretics and thiazide diuretics appear to reduce the risk of death and worsening HF compared with a placebo.
- Diuretics can improve exercise capacity.[2]
- Loop diuretics and thiazides act synergistically and may be used to treat diuretic resistance.
- ARNI, MRAs, and SGLT2 inhibitors may also possess diuretic properties.
- Maintaining the euvolemia state is the aim of diuretic therapy with the lowest doses.[3]
- Patients should be trained to self-adjust their diuretic dose based on monitoring of symptoms/signs of congestion and daily weight measurements.
MRA or Mineralocorticoid receptor antagonists
- In all patients with HFrEF, MRAs (spironolactone or eplerenone) are recommended, in addition to an ACE-I and a beta-blocker, to reduce mortality and the risk of heart failure hospitalization.[4]
- MRAs improve symptoms.
- MRAs block receptors that bind aldosterone and also other steroid hormones (corticosteroid and androgen) receptors.
- Eplerenone is more specific for aldosterone blockade and, therefore, causes less gynaecomastia.
- In patients with impaired renal function and in those with serum potassium concentrations >5.0 mmol/L, MRA should be used with causion.
References
- ↑ Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang W, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ (February 2019). "The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology". Eur J Heart Fail. 21 (2): 137–155. doi:10.1002/ejhf.1369. PMID 30600580. Vancouver style error: initials (help)
- ↑ Faris R, Flather M, Purcell H, Henein M, Poole-Wilson P, Coats A (February 2002). "Current evidence supporting the role of diuretics in heart failure: a meta analysis of randomised controlled trials". Int J Cardiol. 82 (2): 149–58. doi:10.1016/s0167-5273(01)00600-3. PMID 11853901.
- ↑ Rohde LE, Rover MM, Figueiredo Neto JA, Danzmann LC, Bertoldi EG, Simões MV, Silvestre OM, Ribeiro A, Moura LZ, Beck-da-Silva L, Prado D, Sant'Anna RT, Bridi LH, Zimerman A, Raupp da Rosa P, Biolo A (November 2019). "Short-term diuretic withdrawal in stable outpatients with mild heart failure and no fluid retention receiving optimal therapy: a double-blind, multicentre, randomized trial". Eur Heart J. 40 (44): 3605–3612. doi:10.1093/eurheartj/ehz554. PMID 31424503. Vancouver style error: initials (help)
- ↑ Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J (September 1999). "The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators". N Engl J Med. 341 (10): 709–17. doi:10.1056/NEJM199909023411001. PMID 10471456.