Which drug class is most associated with fluid retention and should be avoided in heart failure?

• A. NSAIDs
• B. ACE Inhibitors
• C. Beta-Blockers
• D. Spironolactone

Answer: (A)

Fluid management in heart failure hinges on understanding how certain drugs affect the kidneys and fluid balance. NSAIDs are the drug class most associated with fluid retention. They inhibit prostaglandin synthesis, which reduces dilation of the afferent arteriole in the kidneys. This lowers renal perfusion and glomerular filtration, leading the kidneys to reabsorb more sodium and water. The result is increased preload and edema, which can worsen heart failure symptoms and trigger decompensation. In patients with heart failure who rely on diuretics and RAAS inhibitors to control fluid overload, NSAIDs can blunt these therapies and worsen outcomes. By contrast, ACE inhibitors, beta-blockers, and spironolactone are used to improve heart failure outcomes and reduce fluid overload, so they are not associated with the problematic fluid retention seen with NSAIDs.