Superiority of long-acting to short-acting loop diuretics in the treatment of congestive heart failure.
Superiority of long-acting to short-acting loop diuretics in the treatment of congestive heart failure.
复制标题
长效袢利尿剂在治疗充血性心力衰竭方面优于短效袢利尿剂。
作者：
T. Masuyama;T. Tsujino;H. Origasa;Kazuhiro Yamamoto;T. Akasaka;Y. Hirano;N. Ohte;T. Daimon;S. Nakatani;Hiroshi Ito
背景
利尿剂是心力衰竭(HF)患者最常用的药物。然而，缺乏关于其长期影响的临床证据。本研究的目的是比较速尿和阿佐塞米对慢性心力衰竭(CHF)患者的疗效。
方法和结果
在这项多中心、前瞻性、随机、开放、盲目终点试验中，我们比较了阿佐塞米和速尿对CHF患者和纽约心脏协会II级或III级症状的影响。对320例患者(每组160例，平均年龄71岁)进行了至少2年的随访。主要终点包括心血管死亡或因充血性心力衰竭而意外入院。在35.2个月的中位随访期内，阿佐塞米组23名患者和速尿组34名患者出现了主要终点(危险比[HR]，0.55，95%可信区间[CI]0.32-0.95：P=0.03)。在次要终点中，与速尿组相比，阿佐塞米组因充血性心力衰竭而非计划入院或需要修改心力衰竭治疗方案的情况也有所减少(HR，0.60，95%CI0.36~0.99：P=0.048)。
结论
与速尿相比，阿佐塞米降低了心血管病死亡或因充血性心力衰竭而意外入院的风险。
BACKGROUND
Diuretics are the most prescribed drug in heart failure (HF) patients. However, clinical evidence about their long-term effects is lacking. The purpose of this study was to compare the therapeutic effects of furosemide and azosemide, a short- and long-acting loop diuretic, respectively, in patients with chronic heart failure (CHF).
METHODS AND RESULTS
In this multicenter, prospective, randomized, open, blinded endpoint trial, we compared the effects of azosemide and furosemide in patients with CHF and New York Heart Association class II or III symptoms. 320 patients (160 patients in each group, mean age 71 years) were followed up for a minimum of 2 years. The primary endpoint was a composite of cardiovascular death or unplanned admission to hospital for congestive HF. During a median follow-up of 35.2 months, the primary endpoint occurred in 23 patients in the azosemide group and in 34 patients in the furosemide group (hazard ratio [HR], 0.55, 95% confidence interval [CI] 0.32-0.95: P=0.03). Among the secondary endpoints, unplanned admission to hospital for congestive HF or a need for modification of the treatment for HF were also reduced in the azosemide group compared with the furosemide group (HR, 0.60, 95%CI 0.36-0.99: P=0.048).
CONCLUSIONS
Azosemide, compared with furosemide, reduced the risk of cardiovascular death or unplanned admission to hospital for congestive HF.
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