Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure
Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure
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DOI：
10.1016/s0002-9343(01)00903-2
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发表时间：
2001-11-01
影响因子：
5.9
通讯作者：
Brater, DC
中科院分区：
文献类型：
--
作者：
Murray, MD;Deer, MM;Brater, DC
目的：由于口服呋塞米的生物利用度是不稳定的，而且常常是不完整的，我们检验了这样一个假设，即心力衰竭患者接受托尔塞米（一种可预测吸收的利尿剂）治疗，会比接受呋塞米治疗的患者有更有利的临床结果。患者和方法：我们对234名来自城市公共卫生保健系统的慢性心力衰竭患者（平均[+/- SD]年龄，64 +/- 11岁）进行了一项开放标签试验。患者口服托塞米（n = 113）或呋塞米（n = 121） 1年。主要终点是因心力衰竭再入院。次要终点包括所有心血管原因和所有原因的再入院、住院天数和与健康相关的生活质量。结果：与呋塞米治疗的患者相比，托塞米治疗的患者因心力衰竭（39例[32%]对19例[17%]，P < 0.01）或所有心血管原因（71例[59%]对50例[44%]，P = 0.03）而再次入院的可能性更小。两组全因住院率无差异（92例[76%]对80例[71%]，P = 0.36）。接受托尔塞米治疗的患者因心力衰竭住院天数明显减少（106天vs 296天，P = 0.02）。在托尔塞米治疗的患者中，呼吸困难和疲劳评分较基线的改善更大，但仅在第2、8和12个月的疲劳评分上差异有统计学意义。结论：与呋塞米治疗的患者相比，托尔塞米治疗的患者因心力衰竭和所有心血管原因再次入院的可能性更小，并且疲劳程度更低。如果我们的结果被盲法试验证实，托尔塞米可能是慢性心力衰竭患者首选的利尿剂。(C) 2001年由摘录医学公司
PURPOSE: Because the bioavailability of oral furosemide is erratic and often incomplete, we tested the hypothesis that patients with heart failure who were treated with torsemide, a predictably absorbed diuretic, would have more favorable clinical outcomes than would those treated with furosemide.PATIENTS AND METHODS: We conducted an open-label trial of 234 patients with chronic heart failure (mean [+/- SD] age, 64 +/- 11 years) from an urban public health care system. Patients received oral torsemide (n = 113) or furosemide (n = 121) for I year. The primary endpoint was readmission to the hospital for heart failure. Secondary endpoints included readmission for all cardiovascular causes and for all causes, numbers of hospital days, and health-related quality of life.RESULTS: Compared with furosemide-treated patients, torsemide-treated patients were less likely to need readmission for heart failure (39 [32%] vs. 19 [17%], P < 0.01) or for all cardiovascular causes (71 [59%] vs. 50 [44%], P = 0.03). There was no difference in the rate of admissions for all causes (92 [76%] vs. 80 [71%], P = 0.36). Patients treated with torsemide had significantly fewer hospital days for heart failure (106 vs. 296 days, P = 0.02). Improvements in dyspnea and fatigue scores from baseline were greater among patients treated with torsemide, but the differences were statistically significant only for fatigue scores at months 2, 8, and 12.CONCLUSIONS: Compared with furosemide-treated patients, torsemide- treated patients were less likely to be readmitted for heart failure and for all cardiovascular causes, and were less fatigued. If our results are confirmed by blinded trials, torsemide may be the preferred loop diuretic for patients with chronic heart failure. (C) 2001 by Excerpta Medica, Inc.