The effects of adding torasemide to standard therapy on peak oxygen consumption, natriuretic peptides, and quality of life in patients with compensated left ventricular systolic dysfunction.
OBJECTIVE
Diuretics, when used to treat congestion in patients with chronic heart failure, improve symptoms and, perhaps, prognosis but little information is available to guide their use in patients with left ventricular systolic dysfunction (LVSD) who are not congested. Chronic diuretic therapy causes persistent and potentially harmful neuroendocrine activation. Alternatively, in patients in whom neuroendocrine activation is blocked with angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers, diuretics may be beneficial by decreasing preload and afterload and preventing congestion. We aimed to assess the effect of the loop diuretic, torasemide on quality of life, and surrogate markers of prognosis when given to patients with LVSD who were not clinically congested and who were optimally treated with ACE-inhibitors (or angiotensin receptor antagonists) and beta-blockers.


RESULTS
Thirty patients with stable LVSD who had no clinically detectable fluid overload were randomized to receive either torasemide 5 mg daily or placebo for 3 months (Phase A), and after a washout phase of 2 months, cross-over was performed for 3 months (Phase B). Diuretic therapy did not cause significant change in peak VO(2), mean N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) levels, or measures of quality of life compared with placebo. Diuretic therapy did however lead to significant fall in systolic and diastolic blood pressures and increase in plasma renin levels compared with placebo.


CONCLUSIONS
Diuretic therapy with torasemide is not superior to placebo in improving peak VO(2) or reducing NT-proBNP levels in patients with left ventricular dysfunction who are not clinically congested.
Department of Cardiology, Wythenshawe Hospital, Manchester, UK. sanjay.gupta.uk@googlemail.com
Sanjay
S
Gupta
Carolyn
C
Waywell
Nandkumar
N
Gandhi
Nigel
N
Clayton
Brian
B
Keevil
Andrew L
AL
Clark
Leong L
LL
Ng
Nicholas
N
Brooks
Ludwig
L
Neyses
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D018592:Cross-Over Studies; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D057194:Intention to Treat Analysis; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption / Q000187:drug effects*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011788:Quality of Life; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D013599:Systole / Q000502:physiology; D000077786:Torsemide; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000503:physiopathology
D004232:Diuretics; D010446:Peptide Fragments; D013449:Sulfonamides; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D012083:Renin; D000077786:Torsemide