Los diuréticos constituyen una de las piedras angulares del tratamiento de la insuficiencia cardiaca. La correcta utilización de estos agentes exige conocer adecuadamente su farmacodinámica y farmacocinética, sus interacciones y las posibles causas de ineficacia, así como sus peligros potenciales. Para evitarlos deben mantenerse unas normas básicas que incluyen el empleo de las dosis más bajas que consigan mantener al paciente libre de edema, el control periódico de la función renal y los electrolitos séricos, y la utilización amplia de asociaciones entre diuréticos potentes (de asa) y antialdosterónicos. Actualmente no disponemos de datos sobre el impacto que estos fármacos pueden tener en la supervivencia de los pacientes con insuficiencia cardiaca. Posiblemente, pocos campos como éste se presten a ejercer en toda su amplitud la ars medicae.
Palabras clave
Diuréticos
Insuficiencia cardiaca
Edema
Este artículo solo puede leerse en
pdf
Bibliografía
[1.]
M. Awazu, I. Ichikawa.
Alterations in renal function in experimental congestive heart failure.
Semin Nephrol, (1994), 14 pp. 401-411
[2.]
D. Rouse, W.N. Suki.
Effects of neural and humoral agents on the renal tubules in congestive heart failure.
Sem. Nephrol, (1994), 14 pp. 412-420
[3.]
J.A. Miller, S.W. Tobe, K.L. Skorecki.
Control of extracellular fluid volume and the pathophysiology of edema.
The kidney, 5th ed., WB Saunders Company,
[4.]
J. Cosin, J.M. Cruz Fernández, E. De Teresa Galván, I. Ferreira Montero, J.l. López-Sendón, J. Soler Soler, et al.
Factores neurohormonales en la insuficiencia cardíaca (I, II y III).
Rev Esp Cardiol, (1996), 49 pp. 239-252
[5.]
E.B. Raftery.
Hemodynamic effects of diuretics in heart failure.
Br Heart J, (1994), 72 pp. 44-52
[6.]
A.C. Guyton, J.E. Hall.
Regulación de la osmolaridad y de la concentración de sodio del líquido extracelular.
Tratado de fisiología médica, McGraw-Hill, (1997),
[7.]
K.T. Weber, D. Villarreal.
Aldosterone and antialdosterone therapy in congestive heart failure.
Am J Cardiol, (1993), 71 pp. A3-A12
[8.]
E.K. Jackson.
Vasopressin and other agents affecting the renal conservation of water.
Goodman & Gilman's The pharmacological basis of therapeutics, 9th ed., McGraw-Hill Book Co.,
[9.]
A. Sagnella.
Measurement and importance of plasma brain natriuretic peptide and related peptides.
Ann Clin Biochem, (2001), 38 pp. 83-93
[10.]
D.C. Brater.
Pharmacokinetics of loop diuretics in congestive heart failure.
Br Heart J, (1994), 72 pp. S40-S48
[11.]
A.J. Reyes.
The increase in serum uric acid concentration caused by diuretics might be beneficial in heart failure.
Eur J Heart Fail, (2005), 7 pp. 461-467
[12.]
B. López, R. Querejeta, A. González, E. Sánchez, M. Larman, J. Díez.
Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure.
J Am Coll Cardiol, (2004), 43 pp. 2028-2035
[13.]
B. López Salazar, A. González Miqueo, R. Querejeta Iraola, M. Larman Tellechea, J. Díez Martínez.
Caracterización del mecanismo molecular del efecto antifibrótico de la torasemida en la insuficiencia cardiaca.
Rev Esp Cardiol, (2006), 59 pp. 116
[14.]
J. Yoshida, K. Yamamoto, T. Mano, Y. Sakata, M. Nishio, T. Ohtani, et al.
Different effects of long- and short-acting loop diuretics on survival rate in Dahl high-salt heart failure model rats.
Cardiovasc Res, (2005), 68 pp. 118-127
[15.]
ALLHAT Collaborative Research Group.
Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT).
JAMA, (2000), 283 pp. 1967-1975
[16.]
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in highrisk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
JAMA, (2002), 288 pp. 2891-2997
[17.]
B. Pitt, F. Zannad, W.J. Remme, R. Cody, A. Castaigne, A. Pérez, et al.
The effect of spironolactone on morbidity and mortality in patients with heart failure.
N Engl J Med, (1999), 341 pp. 709-717
[18.]
B. Pitt, W. Remme, F. Zannad, J. Neaton, F. Martinez, B. Roniker, et al.
Eplerenone, a selective aldosterona blocker, in patients with left ventricular dysfunction after myocardial infaction.
N Engl J Med, (2003), 348 pp. 1308-1321
[19.]
B. Pitt, H. White, J. Nicolau, F. Martinez, M. Gheorhiade, M. Aschermann, et al.
Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure.
J Am Coll Cardiol, (2005), 46 pp. 425-431
[20.]
D.W. Rudy, J.R. Voelker, P.K. Greene, F.A. Esparza, D.C. Brater.
Loop diuretics for chronic renal insufficiency: a continuous infusion is more efficacious than bolus therapy.
Ann Intern Med, (1991), 115 pp. 360-366
[21.]
D.H. Lawson, J. Gray, D.A. Henry, W.J. Tilstone.
Continuous infusion of furosemida in refractory oedema.
BMJ, (1978), 2 pp. 476
[22.]
M. Lahav, A. Regev, P. Ra’Anani, E. Theodor.
Intermittent administration of furosemide vs continuous infusion preceded by a loading dose for congestive heart failure.
Chest, (1992), 102 pp. 725-731
[23.]
L.P. Rybak.
Pathophysiology of furosemoide ototoxicity.
J Otolaryngol, (1982), 11 pp. 127-133
[24.]
K.S. Channer, K.A. McLean, P. Lawson-Matthew, M. Richardson.
Combination diuretic treatment in severe heart failure: randomized controlled trial.
Br Heart J, (1994), 71 pp. 146-150
[25.]
D.N. Juurlink, M.M. Mamdani, D.S. Lee, A. Kopp, P.C. Austin, A. Laupacis, et al.
Rates of hyperkalemia after publication of the randomized aldactone evaluation study.
N Engl J Med, (2004), 351 pp. 543-551
[26.]
M. Packer, M. O’Connor, J.K. Ghali, M.L. Pressler, P.E. Carson, R.N. Belkin, et al.
Effect of amlodipine on morbidity and mortality in severe chronic heart failure.
N Engl J Med, (1996), 335 pp. 1107-1114
[27.]
G.W. Neuberg, C.M. O’Connor, A.B. Miller, R.N. Belkin, P.E. Carson, A.B. Cropp, et al.
High diuretic doses are associated with sudden death in patients with advanced heart failure: The PRAISE Trial (abstract).
Circulation, (1998), 98 pp. I300
[28.]
D.S. Siscovick, T.E. Raghunathan, B.M. Psaty, T.D. Koepsell, K.G. Wicklund, X. Lin, et al.
Diuretic therapy for hypertension and the risk of primary cardiac arrest.
N Engl J Med, (1994), 330 pp. 1852-1857
[29.]
R. Faris, M. Flather, H. Purcell, M. Henein, P. Poole-Wilson, A. Coats.
Current evidence supporting the role of diuretics in heart failure: a meta analysis of randomised controlled trials.
Int J Cardiol, (2002), 82 pp. 149-158
[30.]
A. Ahmed, A. Husain, T.E. Love, G. Gambassi, L.J. Dell’Italia, G.S. Francis.
Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods.
Eur Heart J, (2006), 27 pp. 1431-1439
[31.]
M. Moser.
Effect of diuretics on morbidity and mortality in the treatment of hypertension.
Cardiology, (1994), 84 pp. 27-35
[32.]
E.D. Freis.
The efficacy and safety of diuretics in treating hypertension.
Ann Intern Med, (1995), 122 pp. 223-231
[33.]
A.W. Hoes, D.E. Grobbe, T.M. Peet.
Do non-potassium-sparing diuretics increase the risk of sudden cardiac death in hypertensive patients?.
Recent evidence. Drugs, (1994), 47 pp. 711-733
Copyright ©
2007. Sociedad Española de Cardiología