Could a Low-Dose Diuretic Polypill Improve Outcomes in Heart Failure With Preserved Ejection Fraction?
Could a Low-Dose Diuretic Polypill Improve Outcomes in Heart Failure With Preserved Ejection Fraction?
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DOI：
10.1161/circheartfailure.120.008090
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Shah SJ
中科院分区：
文献类型：
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作者：
Khan SS;Huffman MD;Shah SJ
心力衰竭每年导致30多万人死亡1和近100万人住院。2射血分数(HFpEF)保留的心力衰竭占心力衰竭总数的50%以上，鉴于人口老龄化和肥胖症和糖尿病患病率上升，心力衰竭的患病率继续上升。3尽管在降低射血分数的心力衰竭治疗方面取得了重大进展，但HFpEF中的4种疾病修饰疗法仍然有限。使用LOOP和噻嗪利尿剂治疗以充血为靶点仍然是治疗的基石，5，6但关于辅助治疗、盐皮质激素受体拮抗剂(MRA)和葡萄糖共转运体2抑制剂(SGLT2i)的益处的新数据很有希望，至少有14项正在进行的研究在HFpEF中检验这些药物。然而，考虑到临床惰性、依从性和HFpEF患者越来越多的多药治疗带来的挑战，吸收方面的差距可能会持续存在，如果不是扩大的话。在这里，我们描述了HFpEF的临床需求，总结了我们反对的理由，提出了反对的潜在论点，并提供了固定低剂量联合治疗HFpEF的路线图，其中包括环状利尿剂、噻嗪或噻嗪类利尿剂、MRA和SGLT2i。
Heart failure (HF) contributes to over 300 000 deaths1 and nearly 1 million hospitalizations annually. 2 HF with preserved ejection fraction (HFpEF) accounts for over 50% of all HF, and prevalence continues to increase given an aging population and rising prevalence of obesity and diabetes. 3 Despite significant advances in the treatment of HF with reduced ejection fraction, 4 disease-modifying therapies in HFpEF remain limited. Targeting congestion with loop and thiazide diuretic therapy remains the cornerstone of treatment, 5, 6 but emerging data on the benefits of adjunctive therapies, mineralocorticoid receptor antagonists (MRA), and sodium glucose co-transporter 2 inhibitors (SGLT2i), are promising with at least 14 ongoing studies examining these agents in HFpEF. However, gaps in uptake are likely to persist, if not grow, given challenges with clinical inertia, adherence, and increasing polypharmacy in patients with HFpEF. Herein, we describe the clinical need, summarize our rationale for, address potential arguments against, and provide a roadmap for a fixed lowdose combination therapy (or “polypill”) for HFpEF, incorporating loop diuretics, thiazide, or thiazide-like diuretics, MRA, and SGLT2i.