The rational use of diuretics in heart failure.

Congestive heart failure is a progressive hemodynamic disorder associated with significant morbidity and mortality. Concomitant renal dysfunction is frequently seen in patients with heart failure, and can compromise fluid regulation, leading to acute decompensation, and increased morbidity and mortality. Diuretic therapy has been the mainstay for treatment of congestive symptoms, despite documented mortality benefits. Misuse or overuse of diuretics can have negative consequences in heart failure, and optimizing diuretic efficiency may improve outcomes. In addition, new agents targeting elevated neuropeptides may prove to be beneficial in regulating fluid status and optimizing renal function.