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Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for

A Conde-Martel1, J C Trullàs2, J L Morales-Rull3

  • 1Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.

Revista Clinica Espanola
|January 12, 2024
PubMed

Insights

Adding hydrochlorothiazide to furosemide effectively treats acute heart failure, showing similar benefits for men and women. However, women experienced a higher incidence of worsening renal function.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Acute heart failure (AHF) management often involves diuretics.
  • The CLOROTIC trial demonstrated hydrochlorothiazide (HCTZ) plus furosemide improved diuretic response in AHF.
  • Investigating sex-based differences in AHF treatment response is crucial.

Purpose of the Study:

  • To analyze sex-specific clinical characteristics and outcomes in AHF patients treated with HCTZ plus furosemide.
  • To evaluate the efficacy and safety of HCTZ addition to furosemide in AHF, stratified by sex.

Main Methods:

  • Post-hoc analysis of the CLOROTIC trial (n=230) in AHF patients.
  • Patients received intravenous furosemide with either HCTZ or placebo.
  • Primary outcomes: changes in weight and dyspnea; secondary outcomes: diuretic response, mortality, and rehospitalizations.

Main Results:

  • Women (48%) were older with higher ejection fraction; men had more ischemic cardiomyopathy and higher natriuretic peptides.
  • HCTZ addition improved weight loss, diuretic response, and 24-hour diuresis similarly in both sexes.
  • Worsening renal function was significantly more frequent in women (OR 8.68) than men (OR 2.5).

Conclusions:

  • Hydrochlorothiazide combined with furosemide is effective for improving diuretic response in AHF, irrespective of sex.
  • While generally safe, this combination therapy presents a higher risk of renal function worsening in women.
  • Further research into sex-specific renal responses to diuretic therapy in AHF is warranted.
Abstract

Keywords:
Deterioro de función renalDiureticsDiuréticosHeart failureInsuficiencia cardiacaSexSexoThiazidesTiazidasWorsening renal function

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