Current evidence supporting the role of diuretics in heart failure: a meta analysis of randomised controlled trials.
OBJECTIVE
To summarise the current evidence from randomised controlled trials for diuretics in patients with congestive heart failure (CHF).


METHODS
English-language randomised controlled trials and review papers referenced in Medline, Embase between 1966 and 1999. General literature review of pertinent journals was carried out and reference lists of papers were inspected.


METHODS



METHODS
Meta-analysis of randomised controlled trials of diuretic therapy in patients with CHF.


METHODS
Studies were included if they were randomised comparisons of loop or thiazide diuretics and control, or one diuretic and another active agent (e.g. ACE inhibitors, ibopamine and digoxin).


METHODS
Using a standardised protocol, two reviewers independently abstracted the data and assessed the methodological quality of each paper.


RESULTS
The odds ratio (OR) of treated group compared with control was estimated for each end-point outcome and plotted against each other using the fixed-effects model. THE MAIN OUTCOME MEASURES: The primary outcomes of our analysis were effects of diuretics on mortality and morbidity.


RESULTS
Eighteen trials met our criteria and were eligible for analysis, involving 928 patients. Eight trials were placebo-controlled. We analysed the data for mortality and for worsening heart failure. A further ten trials compared diuretics against other agents such as ACE inhibitors, ibopamine, and digoxin. Mortality data were available in three of the placebo-controlled trials (n=221); the mortality rate was lower for patients treated with diuretics than for control [the odds ratio for death, 0.25; 95% confidence intervals (CI), 0.07-0.84; P=0.03]. Admissions for worsening heart failure in the four small trials (n=448) showed an odds ratio of 0.31 (95% CI 0.15-0.62; P=0.001). In six studies of diuretics compared to active control, diuretics significantly improved exercise capacity in patients with CHF [OR: 0.37; CI: 0.10-0.64, P=0.007].


CONCLUSIONS
Compared to active control, diuretics appear to reduce the risk of worsening disease and improve exercise capacity. The available data from small studies show that in CHF conventional diuretics reduce the risk of death and worsening heart failure compared to placebo.
Faris
R
R
Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. r.al-faris@ic.ac.uk
Flather
M
M
Purcell
H
H
Henein
M
M
Poole-Wilson
P
P
Coats
A
A
D004232:Diuretics / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D004232:Diuretics