title: High-Dose Torasemide is Equivalent to High-Dose Furosemide with Hypertonic Saline in the Treatment of Refractory Congestive Heart Failure.
abstract: OBJECTIVE
  A randomised, double-blind study was performed to evaluate the effects of the combination of high-dose torasemide and hypertonic saline solution (HSS) infusion versus high-dose furosemide (frusemide) and HSS in the treatment of refractory New York Heart Association class IV congestive heart failure (CHF).
  
  
  METHODS
  Eighty-four patients (55 males, 29 females) with refractory CHF, aged 55-84 years, with an ejection fraction <35%, serum creatinine <2 mg/dL, blood urea nitrogen </=60 mg/dL, a reduced urinary volume and a low natriuresis, were randomised to two groups. Group 1 (27 males, 15 females) received an intravenous infusion of furosemide 500mg plus HSS (150mL of 1.4-4.6% sodium chloride) twice daily in 30 minutes. Group 2 (28 males, 14 females) received torasemide 200mg twice daily plus HSS during a period lasting 4-8 days. Physical examination, measurement of bodyweight, blood pressure, heart rate, evaluation of signs of CHF, and serum and urinary parameters were controlled daily during hospitalisation. Chest x-ray, ECG and echocardiogram were obtained at entry, during hospitalisation and at discharge. During the treatment and after discharge the daily dietary sodium intake was 120 mmol, with a fluid intake of 1.0-1.5L in both groups. Bodyweight and 24-hour urinary volume, serum and urinary laboratory parameters, until reaching a compensated state, were controlled daily, when intravenous furosemide and torasemide were replaced with oral furosemide administration only (250-500mg twice daily). After discharge the double-blind design was discontinued and the subsequent period was an open-label study with furosemide only; the patients were followed up as outpatients weekly for the first 3 months and subsequently once a month.
  
  
  RESULTS
  Baseline clinical characteristics of patients were similar in both groups. A significant increase in daily diuresis and natriuresis was observed in both groups. No difference was observed in serum sodium or potassium. Bodyweight was reduced in both groups. Blood pressure values decreased, and heart rate was corrected to normal values in both groups. In the follow-up period (12 +/- 3.9 months), 17 patients were re-admitted to the hospital for heart failure. Thirteen patients died during follow-up.
  
  
  CONCLUSIONS
  We conclude that high-dose torasemide is equivalent to high-dose furosemide in the treatment of refractory CHF.
authors.affiliation: Department of Internal Medicine, University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paterna
authors.forename: Sergio
authors.initials: S
authors.lastname: Fasullo
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pasquale