title: [Chronotherapy with torasemide in hypertensive patients: increased efficacy and therapeutic coverage with bedtime administration].
abstract: OBJECTIVE
  Torasemide is a high ceiling loop diuretic frequently used for treatment of heart failure, renal failure and hypertension, according to results mainly based on clinic blood pressure measurements, without proper evaluation of the 24-hour efficacy of the drug. Accordingly, we investigated the time-dependent antihypertensive efficacy of torasemide in hypertensive patients.
  
  
  METHODS
  We studied 58 patients with grade 1-2 essential hypertension (25 men and 33 women), 48.7 (11.9) years of age, randomly assigned to receive torasemide (5 mg/day) either upon awakening or at bedtime. Blood pressure was measured by ambulatory monitoring for 48 consecutive hours before and after 6 weeks of therapy.
  
  
  RESULTS
  Efficacy of torasemide was significantly higher with bedtime dosing (11.2 and 8.0 mmHg reduction in the 24-hour mean of systolic and diastolic blood pressure, respectively) as compared to the administration of the drug on awakening (6.2 and 3.7 mmHg reduction in systolic and diastolic blood pressure). The percentage of patients with controlled ambulatory blood pressure after treatment was also higher after bedtime treatment (54% versus 27%). The time-response curves indicate a full 24-hour therapeutic duration only when torasemide was administered before bedtime. With regard to the safety profile, 2 patients presented secondary effects (abdominal pain, diarrhea) in morning dose, and 4 patients taking the drug at bedtime reported nicturia.
  
  
  CONCLUSIONS
  A dose of 5 mg/day torasemide is effective for blood pressure reduction after bedtime administration. The differences in efficacy and therapeutic duration as a function of the circadian time of treatment with torasemide here documented should be taken into account when prescribing this loop diuretic for treatment of patients with essential hypertension.
authors.affiliation: Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Calvo
authors.forename: Ramón C
authors.initials: RC
authors.lastname: Hermida
authors.forename: Diana E
authors.initials: DE
authors.lastname: Ayala
authors.forename: José E
authors.initials: JE
authors.lastname: López
authors.forename: Marta
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Luisa
authors.initials: L
authors.lastname: Chayán
authors.forename: Artemio
authors.initials: A
authors.lastname: Mojón
authors.forename: Rita
authors.initials: R
authors.lastname: Soler
authors.forename: María J
authors.initials: MJ
authors.lastname: Fontao
authors.forename: José R
authors.initials: JR
authors.lastname: Fernández
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D019454:Chronotherapy; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013449:Sulfonamides / Q000008:administration & dosage* / Q000009:adverse effects; D000077786:Torsemide; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D013449:Sulfonamides; D000077786:Torsemide