Faris Rajaa F, Flather Marcus, Purcell Henry, Poole-Wilson Philip A, Coats Andrew J S
Department of Cardiology, Prince Sultan Cardiac Centre, P.O. Box: 7897, Riyadh, Saudi Arabia, 11565.
Cochrane Database Syst Rev. 2012 Feb 15(2):CD003838. doi: 10.1002/14651858.CD003838.pub3.
Chronic heart failure is a major cause of morbidity and mortality worldwide. Diuretics are regarded as the first-line treatment for patients with congestive heart failure since they provide symptomatic relief. The effects of diuretics on disease progression and survival remain unclear.
To assess the harms and benefits of diuretics for chronic heart failure
Updated searches were run in the Cochrane Central Register of Controlled Trials in The Cochrane Library (CENTRAL Issue 1 of 4, 2011), MEDLINE (1966 to 22 February 2011), EMBASE (1980 to 2011 Week 07) and HERDIN database (1990 to February 2011). We hand searched pertinent journals and reference lists of papers were inspected. We also contacted manufacturers and researchers in the field. No language restrictions were applied.
Double-blinded randomised controlled trials of diuretic therapy comparing one diuretic with placebo, or one diuretic with another active agent (e.g. ACE inhibitors, digoxin) in patients with chronic heart failure.
Two authors independently abstracted the data and assessed the eligibility and methodological quality of each trial. Extracted data were analysed by determining the odds ratio for dichotomous data, and difference in means for continuous data, of the treated group compared with controls. The likelihood of heterogeneity of the study population was assessed by the Chi-square test. If there was no evidence of statistical heterogeneity and pooling of results was clinically appropriate, a combined estimate was obtained using the fixed-effects model.
This update has not identified any new studies for inclusion. The review includes 14 trials (525 participants), 7 were placebo-controlled, and 7 compared diuretics against other agents such as ACE inhibitors or digoxin. We analysed the data for mortality and for worsening heart failure. Mortality data were available in 3 of the placebo-controlled trials (202 participants). Mortality was lower for participants treated with diuretics than for placebo, odds ratio (OR) for death 0.24, 95% confidence interval (CI) 0.07 to 0.83; P = 0.02. Admission for worsening heart failure was reduced in those taking diuretics in two trials (169 participants), OR 0.07 (95% CI 0.01 to 0.52; P = 0.01). In four trials comparing diuretics to active control (91 participants), diuretics improved exercise capacity in participants with CHF, difference in means WMD 0.72 , 95% CI 0.40 to 1.04; P < 0.0001.
AUTHORS' CONCLUSIONS: The available data from several small trials show that in patients with chronic heart failure, conventional diuretics appear to reduce the risk of death and worsening heart failure compared to placebo. Compared to active control, diuretics appear to improve exercise capacity.
慢性心力衰竭是全球发病和死亡的主要原因。利尿剂被视为充血性心力衰竭患者的一线治疗药物，因为它们能缓解症状。利尿剂对疾病进展和生存的影响仍不明确。
评估利尿剂治疗慢性心力衰竭的利弊。
在Cochrane图书馆的Cochrane对照试验中央登记库（CENTRAL 2011年第1期，共4期）、MEDLINE（1966年至2011年2月22日）、EMBASE（1980年至2011年第7周）和HERDIN数据库（1990年至2011年2月）进行了更新检索。我们手工检索了相关期刊，并检查了论文的参考文献列表。我们还联系了该领域的制造商和研究人员。未设语言限制。
在慢性心力衰竭患者中，比较一种利尿剂与安慰剂，或一种利尿剂与另一种活性药物（如血管紧张素转换酶抑制剂、地高辛）的利尿剂治疗双盲随机对照试验。
两位作者独立提取数据，并评估每个试验的入选资格和方法学质量。通过确定治疗组与对照组二分数据的比值比和连续数据的均值差异来分析提取的数据。通过卡方检验评估研究人群异质性的可能性。如果没有统计学异质性的证据且结果合并在临床上合适，则使用固定效应模型获得合并估计值。
本次更新未发现任何新的纳入研究。该综述包括14项试验（525名参与者），7项为安慰剂对照试验，7项比较了利尿剂与其他药物（如血管紧张素转换酶抑制剂或地高辛）。我们分析了死亡率和心力衰竭恶化的数据。3项安慰剂对照试验（202名参与者）中有死亡率数据。接受利尿剂治疗的参与者死亡率低于安慰剂组，死亡比值比（OR）为0.24，95%置信区间（CI）为0.07至0.83；P = 0.02。在两项试验（169名参与者）中，服用利尿剂的患者因心力衰竭恶化而入院的情况减少，OR为0.07（95%CI为0.01至0.5;P = 0.01）。在四项将利尿剂与活性对照进行比较的试验（91名参与者）中，利尿剂改善了慢性心力衰竭参与者的运动能力，均值差异加权均数差（WMD）为0.72，95%CI为0.40至1.04；P < 0.0001。
来自几项小型试验的现有数据表明，在慢性心力衰竭患者中，与安慰剂相比，传统利尿剂似乎可降低死亡风险和心力衰竭恶化风险。与活性对照相比，利尿剂似乎可改善运动能力。
