Diuretics have an essential role in the management of
heart failure (HF). However, each drug has its own benefit and side effect. Side effects include fluid,
electrolyte abnormalities, and
acid-base disturbance. These adverse effects of
diuretics predispose patients to serious
cardiac arrhythmias and may increase the risk of arrhythmic mortality. Herein, we aim to summarize the relative efficacy and safety of all available
diuretics used in the treatment of patients with HF. In June 2017, a systematic electronic database search was conducted in nine databases. All randomized controlled trials (RCTs) comparing the different
diuretics used in HF were included for meta-analysis. The protocol was registered in Prospero with CRD42018084819. Among the included 54 studies (10,740 patients), 34 RCTs were eligible for quantitative network meta-analysis (NMA) and traditional meta-analysis while the other 20 studies were qualitatively analyzed. Our results showed that
azosemide and
torasemide caused a significant reduction in
brain natriuretic peptide (BNP) level.
Torasemide also caused a significant decrease in
collagen volume fraction (CVF) and
edema. No significant difference between the agents concerning glomerular filtration rate (GFR), water extraction, and
sodium excretion was demonstrated. Regarding side effects, no significant difference among
diuretics was observed in terms of
hospital readmission and mortality rates.
Diuretics are the main treatment of hypervolemia in HF patients. The choice of appropriate
diuretic is essential for successful management and is mainly guided by patient clinical situations and the presence of other co-morbidities.