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

Sanjay Gupta, Carolyn Waywell, Nandkumar Gandhi, Nigel Clayton, Brian Keevil, Andrew L. Clark, Leong L. Ng, Nicholas Brooks, Ludwig Neyses

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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-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-blockers. Methods and 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 VO2, 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. Conclusion: Diuretic therapy with torasemide is not superior to placebo in improving peak VO2 or reducing NT-proBNP levels in patients with left ventricular dysfunction who are not clinically congested. © 2010 The Author.
    Original languageEnglish
    Pages (from-to)746-752
    Number of pages6
    JournalEuropean Journal of Heart failure
    Volume12
    Issue number7
    DOIs
    Publication statusPublished - Jul 2010

    Keywords

    • Diuretics
    • Exercise
    • Heart failure
    • Quality of life
    • Randomized controlled trial
    • Torasemide

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