title: Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD).
abstract: OBJECTIVE
  We sought to determine whether non-potassium-sparing diuretics (PSDs) in the absence of a PSD may result in progressive heart failure (HF).
  
  
  BACKGROUND
  Angiotensin-converting enzyme (ACE) inhibitors incompletely suppress ACE activity in HF patients. Furthermore, non-PSDs are activators of aldosterone secretion. We reasoned that non-PSDs, in the absence of a PSD, might result in progressive HF.
  
  
  METHODS
  In the 6,797 patients in the Studies Of Left Ventricular Dysfunction (SOLVD), we compared the risk of hospitalization for, or death from, HF between those taking a PSD and those who were not, adjusting for known covariates.
  
  
  RESULTS
  The risk of hospitalization from worsening HF in those taking a PSD relative to those taking only a non-PSD was 0.74 (95% confidence interval [CI] 0.55 to 0.99; p = 0.047). The relative risk for cardiovascular death was 0.74 (95% CI 0.59 to 0.93; p = 0.011), for death from all causes 0.73 (95% CI 0.59 to 0.90; p = 0.004), and for hospitalization for, or death from, HF 0.75 (95% CI 0.58 to 0.97; p = 0.030). Compared with patients not taking any diuretic, the risk of hospitalization or death due to worsening HF in patients taking non-PSDs alone was significantly increased (risk ratio [RR] = 1.31, 95% CI 1.09 to 1.57; p = 0.0004); this was not observed in patients taking PSDs with or without a non-PSD (RR = 0.99, 95% CI 0.76 to 1.30; p = 0.95).
  
  
  CONCLUSIONS
  The use of PSDs in HF patients is associated with a reduced risk of death from, or hospitalization for, progressive HF or all-cause or cardiovascular death, compared with patients taking only a non-PSD.
authors.affiliation: Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA. domanskm@NIH.gov
authors.forename: Michael
authors.initials: M
authors.lastname: Domanski
authors.forename: James
authors.initials: J
authors.lastname: Norman
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Mark
authors.initials: M
authors.lastname: Haigney
authors.forename: Stephen
authors.initials: S
authors.lastname: Hanlon
authors.forename: Eliot
authors.initials: E
authors.lastname: Peyster
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D002423:Cause of Death; D018450:Disease Progression; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000378:metabolism; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology
chemical_list: D004232:Diuretics; D000450:Aldosterone; D011188:Potassium