Heart failure: adding thiazides to loop diuretics may help diuresis in resistant cases

Clinical bottom line (level 1b-)

  1. 90% of patients with severe heart failure and fluid retention resistant to loop diuretics who received thiazide diuretics in addition achieved a diuresis.
  2. There was no clear difference between bendrofluazide and metolazone on the degree of diuresis.
Channer et al: British Heart Journal 1994; 71: 146-150
Expires October 2003

The study

Unblinded ?concealed randomised trial ?with intention-to-treat
Setting: university hospital, UK

33 patients (aged range 17 to 86 years; mean 66, 64% male) with 40 episodes of severe congestive heart failure (NYHA class III or IV) and fluid retention unresponsive to loop diuretics for 48 hours (body weight stable or increasing)
Note:
  • All patients received 80 mg furosemide twice daily iv during the study.


    • Control Group: (n = 20, 20 analysed): bendrofluazide 10 mg daily orally for at least 3 days
    Experimental Group: (n = 20, 20 analysed): metolazone 10 mg once daily orally for at least 3 days

    100% followed for 6 days

    The evidence

  • Diuresis was achieved in 93% of patients (95% CI: 84% to 100%)
  • Patients lost 5 kg over 5 to 6 days.
  • No difference in weight loss or sodium, potassium, urea or creatinine was noted between the two groups.

    • Citation

    1. Channer KS, McLean KA, Lawson-Matthew P, et al: combination diuretic treatment in severe heart failure: a randomised controlled trial. British Heart Journal 1994; 71: 146-150
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient resistant heart failure
    Intervention or Exposure thiazide diuretic
    Outcome diuresis