Early Sequential Nephron Blockade in Acute Heart Failure Patients: A Randomised, Controlled Study

Exclusion Criteria

• •Patients who receive furosemide ≥500 mg/day or hydrochlorothiazide ≥100 mg/day or spironolactone ≥100 mg/day or tolvaptan of any doses
• •Patients who have systolic blood pressure \<100 mmHg or who need vasoactive drugs inotropic agents (except dobutamine)
• •Patients with intravascular volume depletion from clinical evaluation
• •Patients with chronic kidney disease stage 5 (estimated glomerular filtration rate \<15 ml/min/1.73 m2) or patients who receive maintenance dialysis
• •Patients who require renal replacement therapy at the time of admission
• •Patients whom diagnosed hypertrophic obstructive cardiomyopathy, severe valvular stenosis or complex congenital heart disease
• •Patients with sepsis or systemic infection
• •Pregnant women
• •Patients who have history of furosemide, spironolactone or hydrochlorothiazide allergy