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LETTER
Drug therapy in chronic heart failure
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  1. O Jolobe
  1. Manchester, UK; oscarjolobeyahoo.co.uk

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      In their recent paper on drug therapy in chronic heart failure the authors addressed all the important issues.1 Blood volume depletion (mediated by drug related augmentation of diuresis) complicates “triple therapy” when spironolactone is co-prescribed with loop diuretics and angiotensin converting enzyme inhibitors.2–4 Therefore, over and above the recommendation to check renal function and potassium levels, I would add that patients on triple therapy should have strict monitoring of their daily weight so as to pre-empt prerenal uraemia by appropriate titration of diuretic dosage.

      References

      1. ↵
        McKenzie DB, Cowley AJ. Drug therapy in chronic heart failure. Postgrad Med J2003;79:634–42.
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      2. ↵
        Ikram H, Webster MWW, Nicholls MG. et al. Combined spironolactone and converting enzyme inhibitor therapy for refractory heart failure. Aust N Z J Med1986;16:61–3.
        OpenUrlPubMedWeb of Science
      3. Jolobe OMP, Efficacy of low-dose captopril in addition to furosemide and spironolactone in patients with decompensated liver disease during blunted diuresis (letter). J Hepatol1993;19:321–2.
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      4. ↵
        Jolobe OMP. Evidence-based medicine: a historical and international review (letter). J R Coll Physicians Edinb2002;32:68.
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