Pharmacotherapy in congestive heart failure: diuretic resistance and strategies to overcome resistance in patients with congestive heart failure.
Congestive heart failure is a complex clinical hemodynamic disorder characterized by chronic and progressive pump failure and fluid accumulation. Although the overall impact of diuretic therapy on congestive heart failure mortality remains unknown, diuretics remain a vital component of symptomatic congestive heart failure management. Over time, sodium and water excretion are equalized before adequate fluid elimination occurs. This phenomenon is thought to occur in one out of three patients with congestive heart failure on diuretic therapy and is termed diuretic resistance. In congestive heart failure, both pharmacokinetic and pharmacodynamic alterations are thought to be responsible for diuretic resistance. Due to disease chronicity, symptomatic management is vital to improved quality of life and enhancing diuretic response is therefore pivotal.
Ravnan
Susan L
SL
University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, CA, USA.
Ravnan
Marcus C
MC
Deedwania
Prakash C
PC
D004232:Diuretics / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D004351:Drug Resistance / Q000502:physiology; D004487:Edema / Q000188:drug therapy; D006333:Heart Failure / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D009318:Natriuresis
D004232:Diuretics