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Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized-26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: - 1.78 ± 1.08 kg/day vs placebo: - 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: - 0.74 ± 0.47 kg/40 mg vs placebo: - 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss.Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .

急性失代偿性心力衰竭（ADHF）是 65 岁及以上患者住院的主要原因，其中大多数患者存在充血症状。使用氢氯噻嗪（HCTZ）可能会增加对袢利尿剂的反应。评估在 ADHF 患者中添加 HCTZ 到呋塞米对充血和症状的影响。这项随机临床试验比较了 HCTZ 50mg 与安慰剂在 ADHF 合并充血体征患者中的 3 天使用效果。该研究的主要结局是每日体重减轻。次要结局是肌酐变化、血管活性药物需求、利钠肽变化、充血评分、呼吸困难、口渴和住院时间。51 名患者被随机分为 HCTZ 组（26 名）和安慰剂组（25 名）。HCTZ 组的体重额外减轻 0.73kg/天（HCTZ：-1.78±1.08kg/天 vs 安慰剂：-1.05±1.51kg/天；p=0.062）。事后分析显示，每 40mg 静脉注射呋塞米，HCTZ 组的体重减轻更显著（HCTZ：-0.74±0.47kg/40mg vs 安慰剂：-0.33±0.80kg/40mg；p=0.032）。HCTZ 组的肌酐有升高趋势（HCTZ：0.50±0.37 vs 安慰剂：0.27±0.40；p=0.05），但急性肾功能衰竭的发生率无显著差异（HCTZ：58% vs 安慰剂：41%；p=0.38）。其余结局无差异。与安慰剂相比，在急性失代偿性心力衰竭患者的常规治疗中添加氢氯噻嗪并没有导致每日体重减轻的显著差异。在调整静脉注射呋塞米剂量的分析中，HCTZ 50mg 与呋塞米联合使用对体重减轻有显著的协同作用。