Hydrochlorothiazide congestive heart failure

Chlorothiazide [klor oh THYE a zide], the prototype thiazide diuretic, was the first modern diuretic that was active orally and was capable of affecting the severe edema of cirrhosis and congestive heart failure with a minimum of side effects. Its properties are representative of the thiazide group, although newer derivatives such as hydrochlorothiazide or chlorthalidone are now used more commonly. 

Triamterene may be u.sed alone in the treatment of mild edema associated with congestive heart failure or cirrhosis of the liver with ascites, but it should not be given to patients with impaired renal function." It is not to be used alone in the treatment of hypertension. - Its primary use is in combination with hydrochlorothiazide (or other diuretics that act at site 2 or 3) to prevent the hypokalemia associated with the latter diuretics. 

FIGURE 49-6. Therapeutic algorithm for diuretic use in patients with congestive heart failure. GFR, glomerular filtration rate FHCTZ, hydrochlorothiazide. 

A. Diuretics Diuretics are often used in congestive heart failure before digitalis and other drugs are considered. Furosemide is a very useful agent for immediate reduction of the pulmonary congestion and severe edema associated with acute congestive heart failure or severe chronic failure. Thiazides such as hydrochlorothiazide are often used in the management of mild... 

In usual practice, however, it is given in conjunction with hydrochlorothiazide (HCTZ) particularly in the treatment of edema linked with congestive heart failure, cirrhosis of the liver, and the nephrotic syndrome. 

X 10 M), which is one of the most active ACE inhibitors. Enalaprilat causes a drop in blood pressure, as does captoprU. Enalapril is widely used to treat hypertension and congestive heart failure, and is available alone and in combination with hydrochlorothiazide. Enalapril was approved for marketing by the EDA in December 1985 [A. A. Patchett et al.. Nature 1980, 288, 280 E. H. Ulm, Drug Metab. Rev. 1983, 14, 99]. 

Diuretics are used to increase the volume of urine excreted by the kidneys. They are effective in the treatment of edema associated with congestive heart failure. The thiazide diuretics (e.g., hydrochlorothiazide) have antihypertensive activity and are used to control blood pressure either alone or in combination with other antihypertensive agents. Spironolactone (an aldosterone antagonist) and amiloride are potassium-sparing diuretics. 

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