【How to choose diuretics in patients with heart failure】
Diuretics play a key role in the treatment of heart failure, and commonly used diuretics are loop diuretics and thiazides.
Loop diuretics increase urinary sodium excretion, reaching 20% to 25% of sodium filtration overload, and can enhance the removal of free water. Contrary to the thiazides that act on the original curved renal tubules, the fraction of increasing urine sodium excretion is only 5% to 10% of the sodium filtration complex, and reducing the clearance of free water, and it fails in the case of moderate impairment of renal function.
Loop diuretics such as furosemide or torasemide are therefore the drug of choice for most patients with heart failure, especially in patients with significant fluid retention or associated impaired renal function.
The dose of furosemide is linear with the effect, so the dose is not limited. Thiazides are only suitable for patients with heart failure with mild fluid retention with hypertension and normal renal function. Hydrochlorothiazide 100 mg/day has reached the maximum effect, and the further increase is ineffective.
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