CLINICAL RESEARCH: HEART FAILURE
Diuretic use, progressive heart failure, and death in patients in the studies of left ventricular dysfunction (SOLVD)
Michael Domanski, MD*,*,
James Norman, PhD*,
Bertram Pitt, MD ,
Mark Haigney, MD ,
Stephen Hanlon, MD and
Eliot Peyster*
* Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Department of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
National Naval Center Medical Center, Bethesda, Maryland, USA
Manuscript received October 16, 2002;
revised manuscript received March 19, 2003,
accepted March 27, 2003.
* Reprint requests and correspondence: Dr. Michael Domanski, National Heart, Lung, and Blood Institute, 6701 Rocklege Avenue, Bethesda, Maryland 20892-7936, USA.
domanskm{at}NIH.gov
OBJECTIVES: We sought to determine whether non–potassium-sparing diuretics (PSDs) in the absence of a PSD may result in progressive heart failure (HF).
BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors incompletely suppress ACE activity in HF patients. Furthermore, non-PSDs are activators of aldosterone secretion. We reasoned that non-PSDs, in the absence of a PSD, might result in progressive HF.
METHODS: In the 6,797 patients in the Studies Of Left Ventricular Dysfunction (SOLVD), we compared the risk of hospitalization for, or death from, HF between those taking a PSD and those who were not, adjusting for known covariates.
RESULTS: The risk of hospitalization from worsening HF in those taking a PSD relative to those taking only a non-PSD was 0.74 (95% confidence interval [CI] 0.55 to 0.99; p = 0.047). The relative risk for cardiovascular death was 0.74 (95% CI 0.59 to 0.93; p = 0.011), for death from all causes 0.73 (95% CI 0.59 to 0.90; p = 0.004), and for hospitalization for, or death from, HF 0.75 (95% CI 0.58 to 0.97; p = 0.030). Compared with patients not taking any diuretic, the risk of hospitalization or death due to worsening HF in patients taking non-PSDs alone was significantly increased (risk ratio [RR] = 1.31, 95% CI 1.09 to 1.57; p = 0.0004); this was not observed in patients taking PSDs with or without a non-PSD (RR = 0.99, 95% CI 0.76 to 1.30; p = 0.95).
CONCLUSIONS: The use of PSDs in HF patients is associated with a reduced risk of death from, or hospitalization for, progressive HF or all-cause or cardiovascular death, compared with patients taking only a non-PSD.
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Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | CI | | confidence interval | | HF | | heart failure | | PSD | | potassium-sparing diuretic | | RALES | | Randomized ALdactone Evaluation Study | | RR | | risk ratio | | SOLVD | | Studies Of Left Ventricular Dysfunction |
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