Cardiology Letters 2016, 25(4):293-301

Background and principles of effective diuretic treatment in heart failure

Gonçalvesová E, Lesný P, Luknár M

Národný ústav srdcových a cievnych chorôb, a. s. v Bratislave, Slovenská republika

Diuretics are an essential and regular part of the treatment of symptomatic heart failure patients regardless of left ventricular systolic function. The objective of diuretic administration is to remove the congestion which is not only the dominating cause of the symptoms and signs of heart failure but also an important factor of adverse remodeling and progression of myocardial dysfunction. Patients with persistent or recurrent symptoms of congestion have a poor prognosis. On the other hand a higher mortality was observed in the patients with high doses of diuretics. A principle of safe and effective diuretic therapy is to maintain the optivolemic state using the lowest possible doses. The practical implementation of this principle is difficult because of the low sensitivity and specificity of the clinical examination for the detection and quantification of congestion, and also because of the unconstant diuretic response for the same dose of drug. The dosage of diuretics should therefore be flexible, with regular monitoring of electrolytes and renal function, particularly after the change of doses of diuretics, ACE inhibitors and aldosterone receptor antagonists. The review article is devoted to the mechanism of the action, hemodynamic and metabolic effects of diuretics in general, and their individual classes. The authors discuss the views and evidence on the effect of diuretics on the survival of patients with heart failure and perspectives for optimizing their use.

Keywords: diuretic treatment; heart failure; mortality; congestion

Published: April 1, 2016  Show citation