Related Experiment Video
Updated: Nov 8, 2025

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Comparison of diuretic strategies in diuretic-resistant acute heart failure: a systematic review and network
1Department of Medicine, University of Udine, Udine, Italy. luigi.vetrugno@asufc.sanita.fvg.it.
Objective:
Up to 50% of patients hospitalized for acute heart failure (AHF) show resistance to diuretics. This condition contributes to a prolonged hospital length of stay and a higher risk of death. This review aimed to investigate whether a diuretic therapeutic approach more effective than furosemide alone exists for patients with diuretic-resistant AHF.
Materials And Methods:
We identified all randomized controlled trials (RCTs) evaluating diuretic therapy in patients with diuretic-resistant AHF. We searched Pubmed, BioMed Central, and Cochrane CENTRAL databases.
Results:
Six RCTs were identified, involving a total of 845 patients. The P-score ranges from 0.6663 for furosemide to 0.2294 for the tolvaptan-furosemide. We found no significant differences in efficacy for any drug comparison.
Conclusions:
None of the diuretics considered in RCTs performed to date (tolvaptan, metolazone, hydrochlorothiazide, indapamide) appear to be more effective than furosemide therapy alone for the treatment of patients with diuretic-resistant AHF.
Related Concept Videos
Heart Failure Drugs: Diuretics
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
Heart Failure V: Medical Management
Heart Failure IV: Classification and Diagnostic Evaluation
Heart Failure VI: Adjunct Therapies
Antihypertensive Drugs: Action of Diuretics

