Current Heart Failure Reports

, Volume 11, Issue 1, pp 1–9 | Cite as

New Insights into Combinational Drug Therapy to Manage Congestion in Heart Failure

  • Frederik Hendrik Verbrugge
  • Lars Grieten
  • Wilfried Mullens
Pharmacologic Therapy (WHW Tang, Section Editor)


Congestion is the most important contributor to morbidity and mortality in heart failure. In patients without congestion, maintaining a neutral sodium balance is imperative to prevent evolving volume overload. Adequate use of neurohumoral blockers, in combination with dietary sodium restriction, is essential and may preclude the need for maintenance diuretic therapy. If volume overload still prevails, loop diuretics remain the mainstay treatment to reduce excessive extracellular volume. However, combinational drug therapy might offer a more attractive alternative to achieve a balanced natriuresis, instead of further uptitration of loop diuretics. Importantly, elevated cardiac filling pressures may be caused by volume misdistribution and impaired venous capacitance, rather than absolute volume overload. Vasodilator therapy to unload the heart, increase venous capacitance, and lower arterial impedance might be interesting in such cases. This review offers a practical approach into current and potential future pharmacologic therapies for managing congestion, focusing on combinational and targeted therapy.


Acute decompensated heart failure Congestion Diuretics Heart failure Mineralocorticoid receptor antagonists Natriuresis Natriuretic peptides Neurohumoral blockers Nesiritide Oral sodium binders Pharmacologic therapy Serelaxin Sodium Vasodilators Vasopressin antagonists 


Compliance with Ethics Guidelines

Conflict of Interest

Frederik Hendrik Verbrugge, Lars Grieten, and Wilfried Mullens declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Frederik Hendrik Verbrugge
    • 1
    • 2
  • Lars Grieten
    • 1
    • 3
  • Wilfried Mullens
    • 1
    • 3
  1. 1.Department of CardiologyZiekenhuis Oost-LimburgGenkBelgium
  2. 2.Doctoral School for Medicine and Life SciencesHasselt UniversityDiepenbeekBelgium
  3. 3.Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt UniversityDiepenbeekBelgium

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