Diuretic Treatment for the Sodium Retention of Congestive Heart Failure

doi:10.1001/archinte.1994.00420170045004

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Vol. 154 No. 17, 12 September 1994

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Diuretic Treatment for the Sodium Retention of Congestive Heart Failure

Robert J. Cody, MD; Spencer H. Kubo, MD; Kerry K. Pickworth, PharmD

Arch Intern Med. 1994;154(17):1905-1914.

Abstract

The use of diuretics for the treatment of sodium retention incongestive heart failure was evaluated. Particular focus wasgiven to the altered renal response to diuretics in patientswith heart failure and adverse responses to diuretic therapy.Highlighted in-formation included historical aspects of thedevelopment of diuretics, mechanisms of sodium retention, thephysiologic and clinical response to diuretics, and the alteredpharmacokinetics and pharmacodynamics of diuretics in congestiveheart failure. Despite more than 60 years of empiric diureticuse in heart failure, the actual database regarding the long-termefficacy, adverse effects, and altered mortality outcome inheart failure is relatively small. Existent pharmacokineticand pharmacodynamic data are typically not collected withinthe context of heart failure efficacy trials. In addition toaltered electrolyte transport and total-body electrolyte depletion,diuretics may be associated with adverse neurohormonal activation.Thus, guidelines for acute and long-term therapy with diureticsin heart failure remain somewhat empiric. Diuretics will remaina mainstay for the treatment of edema in congestive heart failurebut must be accompanied by moderate sodium restriction. However,large clinical trials of diuretics would be necessary to demonstratethat improved clinical efficacy with edema reduction is notoffset by adverse effects, which include electrolyte depletion,ventricular arrhythmias, and subsequent increased mortality.

(Arch Intern Med. 1994;154:1905-1914)

Author Affiliations

From the Division of Cardiology and Department of Pharmacy, Ohio State University Medical Center, Columbus (Drs Cody and Pickworth); and Cardiovascular Division, University of Minnesota Medical School, Minneapolis (Dr Kubo).

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