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European Heart Journal Advance Access originally published online on February 25, 2005
European Heart Journal 2005 26(7):644-649; doi:10.1093/eurheartj/ehi176
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Diuretic usage in heart failure: a continuing conundrum in 2005

S. Gupta1 and L. Neyses2,*

1Department of Cardiology, Wythenshawe Hospital, Manchester, UK
2Division of Cardiology, University of Manchester, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

Received 17 September 2004; revised 7 January 2005; accepted 27 January 2005; online publish-ahead-of-print 25 February 2005.

* Corresponding author. Tel: +44 161 276 5738; fax: +44 161 276 4149. E-mail address: ludwig.neyses{at}cmmc.nhs.uk

Several large well-designed clinical trials have shown that the use of diuretics is beneficial in patients with hypertension. However, similarly robust data regarding their role in chronic heart failure are lacking. Historically, diuretics were developed for treatment of sodium and water retention in oedematous disorders and clinically, they remain the most potent drugs available to relieve symptoms and eliminate oedema in the congested patient with heart failure. In the non-congested patient, however, diuretics continue to be used on a purely clinical basis without sufficient characterization of benefits, adverse effects, and potential influence on mortality. There are also concerns that chronic diuretic usage can cause adverse vascular effects, unfavourable neuroendocrine activation, electrolyte imbalances, and life-threatening arrhythmias. In this article, we review the limited evidence available regarding the benefits and perils of using diuretics in heart failure.

Key Words: Diuretics • Heart failure • Prognosis


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