Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial

Abstract Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemi...

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Autores principales:	Diogo Silva Piardi, Maurício Butzke, Ana Carolina Martins Mazzuca, Bruna Sessim Gomes, Sofia Giusti Alves, Bruno Jaskulski Kotzian, Eduarda Chiesa Ghisleni, Vanessa Giaretta, Priscila Bellaver, Gabrielle Aguiar Varaschin, Arthur Pereira Garbin, Luís Beck-da-Silva
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f3a183176446485bb7e0fb0736a57c05
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spelling	oai:doaj.org-article:f3a183176446485bb7e0fb0736a57c052021-12-02T18:50:51ZEffect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial10.1038/s41598-021-96002-62045-2322https://doaj.org/article/f3a183176446485bb7e0fb0736a57c052021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-96002-6https://doaj.org/toc/2045-2322Abstract Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized—26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: − 1.78 ± 1.08 kg/day vs placebo: − 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: − 0.74 ± 0.47 kg/40 mg vs placebo: − 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss. Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .Diogo Silva PiardiMaurício ButzkeAna Carolina Martins MazzucaBruna Sessim GomesSofia Giusti AlvesBruno Jaskulski KotzianEduarda Chiesa GhisleniVanessa GiarettaPriscila BellaverGabrielle Aguiar VaraschinArthur Pereira GarbinLuís Beck-da-SilvaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Diogo Silva Piardi Maurício Butzke Ana Carolina Martins Mazzuca Bruna Sessim Gomes Sofia Giusti Alves Bruno Jaskulski Kotzian Eduarda Chiesa Ghisleni Vanessa Giaretta Priscila Bellaver Gabrielle Aguiar Varaschin Arthur Pereira Garbin Luís Beck-da-Silva Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
description	Abstract Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized—26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: − 1.78 ± 1.08 kg/day vs placebo: − 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: − 0.74 ± 0.47 kg/40 mg vs placebo: − 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss. Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .
format	article
author	Diogo Silva Piardi Maurício Butzke Ana Carolina Martins Mazzuca Bruna Sessim Gomes Sofia Giusti Alves Bruno Jaskulski Kotzian Eduarda Chiesa Ghisleni Vanessa Giaretta Priscila Bellaver Gabrielle Aguiar Varaschin Arthur Pereira Garbin Luís Beck-da-Silva
author_facet	Diogo Silva Piardi Maurício Butzke Ana Carolina Martins Mazzuca Bruna Sessim Gomes Sofia Giusti Alves Bruno Jaskulski Kotzian Eduarda Chiesa Ghisleni Vanessa Giaretta Priscila Bellaver Gabrielle Aguiar Varaschin Arthur Pereira Garbin Luís Beck-da-Silva
author_sort	Diogo Silva Piardi
title	Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
title_short	Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
title_full	Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
title_fullStr	Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
title_full_unstemmed	Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
title_sort	effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f3a183176446485bb7e0fb0736a57c05
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Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial

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