Combination therapy is considered to be the optimal approach for most patients with heart failure. The following information is excerpted from six tables that provide summaries of recommendations in the report. Close follow-up is advised to detect early evidence of clinical deterioration. In addition, influenza and pneumococcal immunizations are recommended. The recommendations state that diuretics should be prescribed for all patients with symptoms of heart failure and evidence of a predisposition to fluid retention.
Diuretics are the only reliable means of controlling fluid retention associated with heart failure.
The goal of diuretic therapy is to eliminate symptoms and physical signs of fluid retention, as assessed by jugular venous pressure, peripheral edema, or both. If hypotension or azotemia occurs before symptoms and signs are eliminated, the rapidity of diuresis may be slowed, but diuresis should be maintained until fluid retention is eliminated, as long as the changes in blood pressure and renal function are mild or moderate in severity and do not produce symptoms. Measurement of body weight, preferably daily, is the most useful way to select the diuretic dose and monitor the patient's response to diuretic therapy. Underdosing of diuretics can lead to fluid retention, which may diminish the response to ACE inhibitors and increase the risk of treatment with beta blockers. Overdosing of diuretics can lead to volume depletion, which may increase the likelihood of hypotension with ACE inhibitors and vasodilators and may increase the risk of renal insufficiency with ACE inhibitors and angiotensin II receptor antagonists.