Combinational Diuretics in Heart Failure

Joan Carles Trullàs1, Jesús Casado2, Marta Cobo Marcos3, Francesç Formiga4, J.L. Morales-Rull5, Julio Núñez6, Luís Manzano7
1Internal Medicine Department, Hospital d'Olot I Comarcal de La Garrotxa, Avinguda Dels Països Catalans 86, 17800, Olot, Girona, Spain
2Internal Medicine Department, Hospital Universitario de Getafe, Carretera de Madrid - Toledo, Km 12,500, 28905, Madrid, Spain
3Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
4Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Carrer de La Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
5Internal Medicine Department, Heart Failure Unit, Hospital Universitari Arnau de Villanova, Institut de Recerca Biomédica (IRBLleida), Avinguda Alcalde Rovira Roure, 80, 25198, Lleida, Spain
6Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
7Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, M-607, 9, 100, 28034, Madrid, Spain

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•• Trullàs JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Sánchez-Marteles M, Conde-Martel A, et al. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J. 2023;44:411–21. https://doi.org/10.1093/eurheartj/ehac689. This trial demonstrates the efficacy of the combination of loop and thiazide diuretics in patients with acute heart failure, who are already on moderate- to high-dose oral loop diuretic therapy (80–240 mg furosemide/day). The CLOROTIC is a welcome addition to a limited evidence base for combination diuretic management of AHF. It shows that HCTZ, an inexpensive thiazide diuretic, is a safe and modestly effective addition to loop diuretic therapy in patients with acute heart failure and volume overload.

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