Abstract
OBJECTIVES--(a) To test the hypothesis that a fixed 3 day course of the combination of a thiazide and loop diuretic is as effective as more prolonged treatment in the management of severe resistant cardiac failure. (b) To compare two thiazide diuretics (bendrofluazide and metolazone) in combination with loop diuretics in the treatment of severe resistant cardiac failure. DESIGN--Randomised study with a 2 x 2 factorial design. SETTING--Provincial teaching hospital. PATIENTS--33 consecutive patients (40 episodes) admitted with severe congestive cardiac failure (New York Heart Association class III or IV) unresponsive to intravenous loop diuretics for 48 hours. MAIN OUTCOME MEASURES--Change in daily weight and serum electrolytes and clinical improvement in heart failure. RESULTS--Diuresis was established during 37 of 40 episodes; of the rest two patients died in hospital. On 36 occasions improvement was sufficient to allow discharge from hospital. Median (range) maximal weight loss was -5.05 (-11.3 to 1.6) kg after the addition of bendrofluazide and -5.6 (-12.2 to 4.8) kg after the addition of metolazone (NS). Area under the body weight loss against time curves showed no significant difference between the two thiazide diuretics. Median (range) maximal weight loss after three days of treatment was -5.4 (-12.2 to 4.8) kg and -5.5 (-10.3 to 1) kg after a more prolonged course of median (range) 5.6 (1 to 13) days (NS). Area under the body weight loss time curves showed no significant difference between the two durations of treatment. Bendrofluazide was associated with fewer electrolyte disturbances. CONCLUSIONS--Bendrofluazide and metolazone were equally effective in establishing a diuresis in patients with severe congestive cardiac failure resistant to loop diuretics. A fixed three day course of the combination was as effective as a longer course.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Channer K. S., Richardson M., Crook R., Jones J. V. Thiazides with loop diuretics for severe congestive heart failure. Lancet. 1990 Apr 14;335(8694):922–923. doi: 10.1016/0140-6736(90)90526-b. [DOI] [PubMed] [Google Scholar]
- Cohn J. N., Archibald D. G., Ziesche S., Franciosa J. A., Harston W. E., Tristani F. E., Dunkman W. B., Jacobs W., Francis G. S., Flohr K. H. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1986 Jun 12;314(24):1547–1552. doi: 10.1056/NEJM198606123142404. [DOI] [PubMed] [Google Scholar]
- Cohn J. N., Johnson G., Ziesche S., Cobb F., Francis G., Tristani F., Smith R., Dunkman W. B., Loeb H., Wong M. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991 Aug 1;325(5):303–310. doi: 10.1056/NEJM199108013250502. [DOI] [PubMed] [Google Scholar]
- Ghose R. R., Gupta S. K. Synergistic action of metolazone with "loop" diuretics. Br Med J (Clin Res Ed) 1981 May 2;282(6274):1432–1433. doi: 10.1136/bmj.282.6274.1432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grosskopf I., Rabinovitz M., Rosenfeld J. B. Combination of furosemide and metolazone in the treatment of severe congestive heart failure. Isr J Med Sci. 1986 Nov;22(11):787–790. [PubMed] [Google Scholar]
- Gunstone R. F., Wing A. J., Shani H. G., Njemo D., Sabuka E. M. Clinical experience with metolazone in fifty-two African patients: synergy with frusemide. Postgrad Med J. 1971 Dec;47(554):789–793. doi: 10.1136/pgmj.47.554.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kiyingi A., Field M. J., Pawsey C. C., Yiannikas J., Lawrence J. R., Arter W. J. Metolazone in treatment of severe refractory congestive cardiac failure. Lancet. 1990 Jan 6;335(8680):29–31. doi: 10.1016/0140-6736(90)90148-x. [DOI] [PubMed] [Google Scholar]
- Matthews J. N., Altman D. G., Campbell M. J., Royston P. Analysis of serial measurements in medical research. BMJ. 1990 Jan 27;300(6719):230–235. doi: 10.1136/bmj.300.6719.230. [DOI] [PMC free article] [PubMed] [Google Scholar]