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

Inclusion Criteria: * Age ≥18 years * Diagnosis of acute heart failure which is defined by 2 of the 3 following features: ≥2+ leg edema, jugular venous pressure \>10 cm from physical examination or central venous pressure \>10 mmHg, and bilateral pulmonary edema or bilateral pleural effusion from chest radiography * Patients consent to participate into the 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