Combination of thiazide and loop diuretics for the treatment of acute heart failure

Abstract

Acute heart failure (AHF) is a serious condition with a high mortality rate. It is considered as the most common cause of unplanned hospitalizations in the elderly population. In 90% of all cases AHF presents with congestive symptoms, thus mostly treated with loop diuretics. However, in some cases resistance to loop diuretics develops, causing a major problem. In these cases, despite diuretic treatment, urinary output remains inadequate. Resistance, apart from leading to longer hospitalization and inadequate improvement of congestion, has been shown to be responsible for a worse prognosis compared to properly established diuretic response. Thus, managing resistance is important for which the addition of other diuretics (acting at other targets) may be a solution. The most widely studied of these are thiazide diuretics. Although, previous research suggests that thiazides may be effective in treating diuretic resistance, their early side effects can significantly affect patient survival, therefore their use in combination has not yet been widely adopted. However, the recent CLOROTIC trial has provided promising results on this issue. In our review, we are investigating the use of thiazides in the acute heart failure population in the presence of loop diuretic resistance in the light of these new results.

Keywords

• thiazides
• loop diuretics
• acute heart failure
• diuretic resistance