Publication: higher doses of loop diuretics in heart failure patients
In a study by Jozine ter Maaten and colleagues that was published online this week, we showed that higher doses of loop diuretics in heart failure patients are not only associated with poor outcomes, but are also associated with lower doses of life-saving therapies.
Loop diuretics are used to treat signs and symptoms of volume overload in heart failure patients. However, loop diuretics may also have adverse effects such as lower blood pressure and negative effects on renal function. This is of concern as life-saving therapies for heart failure, such as angiotensin receptor inhibitors and angiotensin receptor blockers, may also have these effects and are often decreased in dose or even discontinued if hypotension or renal function is present. Therefore, inappropriate use of loop diuretics might limit optimal treatment of heart failure patients with life-saving therapies. Indeed, our data indicate that higher doses of loop diuretics are associated with lower use and doses of angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Additionally, we showed that in patients without a decrease in volume overload that received lower doses of loop diuretics over time, the doses of life-saving therapies were increased. Based on our findings we therefore advise to downtitrate doses of loop diuretics in selected euvolemic heart failure patients in order to uptitrate life-saving therapies.
