PROLONGED THERAPY BY THE COMBINATION OF FUROSEMIDE AND THIAZIDES IN REFRACTORY HEART-FAILURE AND OTHER FLUID RETAINING CONDITIONS

The efficacy and side effects of the combination therapy of thiazide a nd furosemide administered to patients with refractory heart failure, for a prolonged period of time, were assessed. Thirty-two patients wer e hospitalized during the years 1985-1991. Left heart failure (left ve ntricular ejection fraction (LVEF = 22.4% +/- 6.6%) was present in 26 patients, right heart failure in 3 patients, chronic renal failure, ci rrhosis and bilateral pleural effusion were present each in one patien t. Chlorothiazide 0.5 g daily was added to conventional therapy. Patie nts were monitored closely during hospitalization and later as outpati ents. During hospitalization, addition of chlorothiazide caused a redu ction of 4.8 +/- 4.0 kg in patients' weight, serum potassium decreased from 4.4 +/- 0.6 to 4.0 +/- 0.5 mmol/l (P < 0.005) and serum sodium f rom 139.0 +/- 4.7 to 136.8 +/- 5.5 mmol/l (P < 0.05). The duration of the combined therapy was 17.2 +/- 19.1 months. Thirteen patients had s hort treatment (1.6 +/- 0.8 months) and 19 patients had prolonged trea tment (26.5 +/- 19.0 months). No specific characteristics distinguishe d patients in both groups. Thiazides were discontinued in 19 patients, 10 of which had side effects. In only 5 of the 19 patients treated fo r the prolonged period had thiazides to be discontinued because of sid e effects. Addition of thiazides to furosemide is efficacious in sever e heart failure. The combination should be started during hospitalizat ion. Many patients can be maintained on this combination for a prolong ed period of time on an ambulatory basis.