Abstract | PATHOGENESIS: All forms of chronic heart failure (high-output and low-output failure) are accompanied by an "arterial underfilling" inducing the activation of various neurohumoral systems (renin-angiotensin-aldosterone system, sympathic nervous system, non-osmotic stimulation of vasopressin). Elevated levels of those neurohormones detrimentally modulate renal function. Subsequently, renal salt and volume retention occurs leading to the main symptoms of heart failure, edema formation and dyspnea. DIURETIC THERAPY:
Diuretics, which have been discovered more than 40 years ago, beneficially influence renal salt- and volume retention by their effects on tubular sodium reabsorption. While thiazides are recommended in mild forms, loop diuretics are used in severe stages of congestive heart failure. The clinician has to consider the changed pharmacokinetic and -dynamic properties during the application of diuretics in patients with chronic heart failure. In addition, increased sodium reabsorption occurs immediately after cessation of diuretic action often nullifying the preceding diuresis. Thus, salt- and volume restriction should be guaranteed, and a regular application of loop diuretics during the day should be preferred due to the short-acting nature of currently available loop diuretics. Sometimes, diuresis does not longer occur during the treatment with one substance ( diuretic resistance), although the therapeutic goals of water excretion have not been achieved. After ruling out factors reducing the actions of diuretics (non-compliance, hyponatremia, etc.), a sequential nephron blockade should be initiated (combination of loop diuretics and a thiazide or an aldosterone-receptor antagonist) to increase diuresis and to elevate symptoms of volume overload. SIDE EFFECTS: CONCLUSION:
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Authors | Michael Christ, Nils Ludwig, Bernhard Maisch |
Journal | Herz
(Herz)
Vol. 27
Issue 2
Pg. 135-49
(Mar 2002)
ISSN: 0340-9937 [Print] Germany |
Vernacular Title | Stellenwert der Aldosteronrezeptorblockade in der diuretischen Therapie von Patienten mit chronischer Herzinsuffizienz. |
PMID | 12025459
(Publication Type: English Abstract, Journal Article, Review)
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Chemical References |
- Benzothiadiazines
- Diuretics
- Diuretics, Osmotic
- Mineralocorticoid Receptor Antagonists
- Receptors, Mineralocorticoid
- Sodium Chloride Symporter Inhibitors
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Topics |
- Benzothiadiazines
- Diuretics
(adverse effects, therapeutic use)
- Diuretics, Osmotic
(adverse effects, therapeutic use)
- Drug Therapy, Combination
- Heart Failure
(drug therapy, physiopathology)
- Hemodynamics
(drug effects, physiology)
- Humans
- Mineralocorticoid Receptor Antagonists
- Receptors, Mineralocorticoid
(physiology)
- Sodium Chloride Symporter Inhibitors
(adverse effects, therapeutic use)
- Water-Electrolyte Balance
(drug effects, physiology)
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