Identificador persistente para citar o vincular este elemento: http://hdl.handle.net/10553/121360
Título: Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial
Autores/as: Trullas, Joan Carles
Morales-Rull, José Luis
Casado, Jesús
Carrera-Izquierdo, Margarita
Sánchez-Marteles, Marta
Conde Martel, Alicia 
Dávila-Ramos, Melitón Francisco
Llácer, Pau
Salamanca-Bautista, Prado
Pérez-Silvestre, José
Plasín, Miguel Ángel
Cerqueiro, José Manuel
Gil, Paloma
Formiga, Francesc
Manzano, Luis
Morales, JL
CLOROTIC Trial Investigators
Clasificación UNESCO: 32 Ciencias médicas
320501 Cardiología
3209 Farmacología
Palabras clave: Heart failure
Diuretics
Thiazides
Hydrochlorothiazide
Furosemide
Fecha de publicación: 2023
Publicación seriada: European Heart Journal 
Resumen: Aims To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF). Methods A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in and results addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48% women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [−2.3 vs. −1.5 kg; adjusted estimated difference (notionally 95% confidence interval) −1.14 (−1.84 to −0.42); P = 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P = 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P = 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P < 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine >26.5 μmoL/L or decrease in eGFR >50%; 46.5 vs. 17.2%; P < 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations. Conclusion The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF.
URI: http://hdl.handle.net/10553/121360
ISSN: 0195-668X
DOI: 10.1093/eurheartj/ehac689
Fuente: European Heart Journal [ISSN 0195-668X], v. 44 (5), p. 411-421, (Febrero 2023)
Colección:Artículos
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