IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Curr Pharm Des. 2024;30(33):2597-2605. doi: 10.2174/0113816128316596240625110337.
Loop diuretics are the cornerstone of decongestive therapy in patients presenting with acute heart failure and have been extensively studied in randomized clinical trials. Therefore, in current guidelines, they are the only drug with a class I recommendation to treat signs and symptoms of congestion when present. However, the percentage of patients achieving successful decongestion is suboptimal, and diuretic resistance frequently develops. Patients with a poor response to loop diuretics and those discharged with residual signs of congestion are characterized by a worse prognosis over time. Recently, a renovated interest in different diuretic classes sprouted among heart failure researchers in order to improve decongestion strategies and ameliorate short- and long-term clinical outcomes. Randomized clinical trials investigating associations among diuretic classes and loop diuretics have been performed but yielded variable results. Therefore, despite initial evidence of a possible benefit from some of these compounds, a definite way to approach diuretic resistance via diuretic combination therapy is still missing. The aim of this review is to summarize current clinical evidence on the use of diuretic combination therapy in patients with acute heart failure and to suggest a possible approach to avoid or counteract diuretic resistance.
利尿剂是治疗急性心力衰竭患者充血症状的基石，在随机临床试验中得到了广泛研究。因此，在当前的指南中，当存在充血症状时，它们是唯一具有 I 类推荐用于治疗充血症状的药物。然而，达到成功充血缓解的患者比例并不理想，并且利尿剂抵抗经常发生。对袢利尿剂反应不佳且出院时仍存在充血迹象的患者随着时间的推移预后更差。最近，心力衰竭研究人员对不同的利尿剂类别产生了新的兴趣，以改善充血缓解策略并改善短期和长期临床结局。已经进行了研究利尿剂类别和袢利尿剂之间关联的随机临床试验，但结果不一致。因此，尽管最初有证据表明这些化合物中的一些可能有益，但仍然缺乏通过利尿剂联合治疗来解决利尿剂抵抗的明确方法。本综述的目的是总结利尿剂联合治疗在急性心力衰竭患者中的临床应用证据，并提出一种可能的方法来避免或对抗利尿剂抵抗。
