Diuretics in cardiovascular therapy. Perusing the past, practising in the present, preparing for the future

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Background:

• Diuretics are primary treatments for cardiovascular disorders like heart failure and hypertension.
• Current understanding of their hemodynamic effects in these conditions is incomplete.
• Existing knowledge primarily focuses on specific diuretics and conditions, leaving many gaps.

Purpose of the Study:

• To review and highlight the existing knowledge gaps in the hemodynamic activities of diuretics.
• To identify areas where more research is needed regarding diuretic effects in cardiovascular diseases.
• To emphasize the need for understanding non-diuretic actions and dose-response relationships.

Main Methods:

• Literature review of studies on diuretic hemodynamic effects.
• Analysis of data on diuretics in acute and chronic heart failure.
• Examination of diuretic efficacy and side effects in hypertension.

Main Results:

• Intravenous furosemide effectively reduces left heart filling pressure in acute myocardial infarction.
• Limited data exists on other intravenous diuretics, oral diuretics, or non-loop diuretics in acute heart failure.
• Information on chronic heart failure, valvular heart disease, and hypertension shows variable effects and significant knowledge gaps.

Conclusions:

• Despite knowledge gaps, diuretics remain first-line treatment for cardiovascular syndromes.
• Further research is urgently needed on the mechanisms of vascular activities and non-diuretic effects of various diuretics.
• Understanding dose-response relationships and comparative efficacy is crucial for optimizing diuretic therapy.