Several short-term studies have shown diuretics to be highly effective in the symptomatic relief of heart failure, decreasing jugular venous pressure, pulmonary congestion, ascites, peripheral edema, and body weight within a few days, and improving cardiac function and exercise tolerance. However, there have been no long-term studies of diuretic therapy in heart failure, mainly because of the ethical difficulties in enrolling symptomatic patients who might benefit from these agents. Thus, the effects on morbidity and mortality are not known. Nor does it appear likely that diuretics will be the subject of future trials of clinical outcome in compensated heart failure, particularly in patients stabilized on angiotensin-converting enzyme (ACE) inhibitors and (3-blockers. For these reasons, diuretics, as underlined by the most recent American College of Cardiology/American Heart Association Guidelines for the Evaluation and Management of Heart Failure, are generally prescribed for all patients with symptomatic heart failure and current or previous fluid retention.
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They are not included in the stage B recommendations for patients with asymptomatic left ventricular systolic dysfunction.
Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001;38:2101-2113.
Parker X). The effects of oral ibopamine in patients with mild heart failure -a double-blind placebo controlled comparison to furosemide. The Ibopamine Study Group. IntJ Cardiol. 1993,40: 221 -227.
Task Force for the diagnosis and treatment of chronic heart failure. European Society of Cardiology. Eur Heart J. 2001;22: 1527-1560. Wilson JR, Reicheck N, Dunkman WB, Goldberg S. Effect of diuresis on the performance of the failing left ventricle in man. Am J Med. 1981;70:234-239.
Drug; diuretic; left ventricular dysfunction; fluid retention.