Lege Artis Medicinae

[THE USE OF DIURETICS AND ALDOSTERONE RECEPTOR ANTAGONISTS IN CHRONIC HEART FAILURE]

NYOLCZAS Noémi

JULY 14, 2007

Lege Artis Medicinae - 2007;17(06-07)

[Diuretics are an integral part of the management of chronic heart failure. Although there are no large, randomized, placebo-controlled, multicentric studies available to show that loop- and thiazid diuretics improve survival, the efficacy of these drugs in relieving heart failure symptoms and fluid retention is indisputable. The third class of diuretics used in heart failure is aldosterone antagonists, whose beneficial effects on mortality and morbidity were demonstrated in the RALES and EPHESUS trials. In this paper, the effects and side effects of the various diuretics, as well as the indications and recommendations on their use are reviewed. New options in diuretic treatment, including adenosine receptor blockers, vasopressin antagonists, atrial natriuretic peptide analogues and ultrafiltration are also presented.]

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[Diuretics are essential therapeutic tools. They effectively reduce blood pressure and have been shown in numerous hypertension clinical trials to reduce both cardiovascular and cerebrovascular morbidity and mortality. In addition, they are important components of the treatment of heart failure with apparent signs of congestion. While thiazides are recommended in mild forms, loop diuretics are used in the severe stages of congestive heart failure. Loop diuretics and thiazides often induce hypokalaemia, which has been demonstrated to be not as benign as thought before. Diuretic-induced hypokalaemia seems to be aldosterone dependent. Aldosterone levels increase during diuretic therapy. Aldosterone antagonists are unique among diuretics in that they improve survival of patients with heart failure independent of their effect on sodium metabolism. Because of this, diuretic treatment lives its renaissance in cardiology.]

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