NSAIDs seem to increase the risks for acute kidney injury when taken along with antihypertensive therapy consisting of a diuretic plus an ACE inhibitior or an ARB.
The hypertension field has been troubled by repeated observations that normal weight patients have more cardiovascular (CV) events than obese patients. Now a new analysis of a large hypertension trial confirms this finding but also suggests that it may be explained by either an adverse effect of diuretics or a protective effect of calcium-channel blockers in non-obese…
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Although ultrafiltration (UF) in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute decompensated heart failure with acute cardiorenal syndrome (type 1), the first clinical trial to test its value shows that it is inferior to standard drug therapy. The results of CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated…
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With all of the hullaballoo about statins and diabetes last week I wanted to point out a paper that was published online this week in Circulation: Cardiovascular Quality and Outcomes. This study examined the long-term effects of incident diabetes on cardiovascular outcomes in patients enrolled in ALLHAT. As you may remember, this trial included more…
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An ideal paper for your next journal club — “Diuretic Strategies in Patients with Acute Decompensated Heart Failure” — was just published in NEJM, by the NHLBI Heart Failure Clinical Research Network. In this study (called DOSE), patients hospitalized with heart failure were randomized to receive different diuretic regimens based on dose and mode of…
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Although widely used for decades, the best way to use loop diuretics in patients with acute decompensated heart failure (ADHF) has never been well studied. The Diuretic Optimization Strategies Evaluation (DOSE) study, published in the New England Journal of Medicine, randomized 308 ADHF patients to a bolus every 12 hours or a continuous infusion of furosemide at…
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At the dosages most often used, hydrochlorothiazide (HCTZ), the most widely used antihypertensive agent in the world, is “consistently inferior” to all other drugs, according to a new meta-analysis published in JACC. Franz Messerli and colleagues performed a systematic review of studies that compared HCTZ to other drugs using 24-hour ambulatory blood pressure monitoring and found…
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