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09-04-2024 | Diuretics | Review

Combinational Diuretics in Heart Failure

Authors: Joan Carles Trullàs, Jesús Casado, Marta Cobo-Marcos, Francesc Formiga, José Luís Morales-Rull, Julio Núñez, Luís Manzano

Published in: Current Heart Failure Reports

Abstract

Purpose of Review

Diuretics are the cornerstone therapy for acute heart failure (HF) and congestion. Patients chronically exposed to loop diuretics may develop diuretic resistance as a consequence of nephron remodelling, and the combination of diuretics will be necessary to improve diuretic response and achieve decongestion. This review integrates data from recent research and offers a practical approach to current pharmacologic therapies to manage congestion in HF with a focus on combinational therapy.

Recent Findings

Until recently, combined diuretic treatment was based on observational studies and expert opinion. Recent evidence from clinical trials has shown that combined diuretic treatment can be started earlier without escalating the doses of loop diuretics with an adequate safety profile.

Summary

Diuretic combination is a promising strategy for overcoming diuretic resistance in HF. Further studies aiming to get more insights into the pathophysiology of diuretic resistance and large clinical trials confirming the safety and efficacy over standard diuretics regimens are warranted.

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Title: Combinational Diuretics in Heart Failure
Authors: Joan Carles Trullàs
Jesús Casado
Marta Cobo-Marcos
Francesc Formiga
José Luís Morales-Rull
Julio Núñez
Luís Manzano
Publication date: 09-04-2024
Publisher: Springer US
Keywords: Diuretics
Acute Heart Failure
Heart Failure
Furosemide
Acetazolamide
Spironolactone
Dapagliflozin
Hydrochlorothiazide
Published in: Current Heart Failure Reports
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI: https://doi.org/10.1007/s11897-024-00659-9

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