scholarly journals Torasemid in the treatment of cardiovascular disease: the optimal use in conditions of comorbidity

2015 ◽  
Vol 12 (4) ◽  
pp. 38-41
Author(s):  
N G Poteshkina ◽  
A A Troshina
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Arterial Hypertension ◽  
Clinical Data ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Therapeutic Practice ◽  
Comprehensive View ◽  
Diuretic Drugs ◽  
Pharmaceutical Industries

The article reviews the current clinical data on the use of one of the modern pharmacological drugs torasemide (Diuver, Teva Pharmaceutical Industries Ltd., Israel) in the treatment of cardiovascular disease in conditions of comorbidity. Presents a comprehensive view of the problem identified and a reasoned approach to the choice of diuretic therapy with clinico-pathophysiological substantiation of the use of a loop diuretic torasemid. Conceptually formed of a number of provisions on the application of one of the modern diuretic drugs in therapeutic practice in patients with arterial hypertension and heart failure.

Torasemide in hypertension and heart failure: re-inventing loop diuretic therapy?

2021 ◽  
Vol 27 ◽  
Author(s):  
Athanasios Manolis ◽  
Manolis Kallistratos ◽  
Michael Doumas
Keyword(s):  
Heart Failure ◽  
Arterial Hypertension ◽  
European Society ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
Hypertensive Patients ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
First Time

: In heart failure (HF) patients, current European Society of Cardiology (ESC) guidelines recommends the use of three loop diuretics (furosemide, torasemide, bumetanide) in order to reduce HF hospitalizations but also to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion. In addition, for the first time in hypertensive patients, European Society of Hypertension (ESH) guidelines recommend the use of torasemide. This review aimed to summarize the mode of action of loop diuretics, to present their pharmacokinetic characteristics, and to discuss their place in the management of arterial hypertension and heart failure, with special emphasis however on torasemide.

Diuretic response and effects of diuretic omission in ambulatory heart failure patients on chronic low‐dose loop diuretic therapy

2021 ◽  
Author(s):  
Jeroen Dauw ◽  
Pieter Martens ◽  
Gregorio Tersalvi ◽  
Joren Schouteden ◽  
Sébastien Deferm ◽  
...  
Keyword(s):  
Heart Failure ◽  
Low Dose ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Heart Failure Patients ◽  
Diuretic Response

Abstract 187: Loop Diuretic Therapy in Acute Decompensated Heart Failure among Premier Hospitals

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Behnood Bikdeli ◽  
Kelly Strait ◽  
Kumar Dharmarajan ◽  
Chohreh Partovian ◽  
Nancy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
High Rate ◽  
Average Daily Dose ◽  
Duration Of Therapy ◽  
Daily Dose ◽  
Hospital Use

Background: Although loop diuretics are frequently used for patients with heart failure (HF), little is known about the variation in patterns of diuretic therapy in US hospitals. We sought to describe such treatment patterns among a diverse group of hospitals. Methods: We studied HF hospitalizations occurring during 2009-10 in Premier Inc. hospitals participating in a collaborative project to pool administrative and charge data, which includes information about drug types, average daily dose, and duration of therapy. We excluded hospitals with less than 25 HF hospitalizations. For ease of comparison, all diuretic doses were converted to bioequivalent doses of intravenous (IV) furosemide: 40mg IV furosemide ∼ 80mg oral furosemide ∼ 20mg (oral or IV) torsemide ∼ 1mg (oral or IV) bumetanide. Summary statistics were calculated. Results: Among 366 studied hospitals (264,675 HF hospitalizations), use of any loop diuretic had an interquartile range (IQR) from 92% to 96% (median: 94%). At the hospital level, the average daily dose IQR varied from 45mg to 64 mg (median: 55 mg) and the median duration of therapy was 4 days (IQR: 4 to 4; median: 4), as was the median length of stay. The IQR for use of furosemide varied from 89% to 94% (median: 92%), and its median average daily dose had an IQR from 40mg to 60 mg (median: 53 mg). Hospital use of bumetanide had an IQR from 2% to 11%, and hospital use of torsemide had an IQR from 0% to 4% (medians of 5% and 1%, respectively). The variation in median average daily dose for bumetanide and torsemide was greater than for furosemide (bumetanide IQR: 79mg to 127 mg, with median of 89 mg; torsemide IQR: 53mg to 120 mg, with median of 80 mg). Use of IV diuretics on the last day before home discharge had an IQR from 16% to 33% (median: 24%) across hospitals. Conclusion: US hospitals administer loop diuretics, particularly furosemide, to the vast majority of HF inpatients. The duration and daily dosage of therapy was similar across most hospitals. In contrast, a minority of hospitals used bumetanide and torsemide for several patients. The daily dosage of these agents showed more marked variation. We observed a high rate of intravenous diuretic use on the last day of hospitalization, with considerable variation across hospitals.

Abstract 18551: Predictors of Heart Failure and Death in a High Risk Diabetic Population: The DAVID-Berg Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mauro Gori ◽  
Paolo Canova ◽  
Alice Calabrese ◽  
Giovanni Cioffi ◽  
Attilio Iacovoni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Clinical Data ◽  
Cox Regression ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Forward Selection ◽  
Left Atrial Volume Index ◽  
Diabetic Population

Introduction: Diabetic subjects are at high risk of heart failure (HF) and death. Few data are available on the predictive value of NTproBNP, ECG, and echocardiogram in this population Hypothesis: A screening strategy with NTproBNP, ECG, and echo may improve prediction of HF/death events in a diabetic population in HF-stages A & B, beyond clinical data Methods: In 2008, among 4047 subjects aged >55 and <80 yrs treated by three general medicine group practices, the DAVID-Berg study enrolled all subjects with diabetes &/or hypertension &/or cardiovascular disease, without history/symptoms/signs of HF (n=623). Subjects underwent clinical visit, 12-lead ECG, echocardiogram, NTproBNP point of care testing. Recently data on HF/death events have been prospectively collected for all diabetic subjects included in the study (n=198) Results: Median age of the study population was 69 yrs, 62% were men, mostly hypertensive (86%) with known cardiovascular disease (44%). During a median follow-up of 5.2 [4.9,5.5] yrs there were 45 HF/death. At Cox regression analyses univariate predictors of events were known cardiovascular disease, insulin therapy, chronic kidney dysfunction (CKD), NTproBNP≥300 pg/mL, abnormal ECG (atrial fibrillation &/or LV hypertrophy &/or bundle branch block &/or Q wave), left atrial volume index (LAVI)≥40 mL/m 2 , LV ejection fraction (LVEF)≤55%, and LV mass index. At multivariate analyses (stepwise forward selection applied to univariate predictors), clinical variables (CKD and known cardiovascular disease), ECG (HR 2.66 [95% CI 1.08-6.55]), LAVI≥40 mL/m 2 (HR 2.50 [95% CI 1.28-4.89]), and LVEF≤55% (HR 2.70 [95% CI 1.45-5.04]) remained significantly associated with the outcome. Adding sequentially NTproBNP, ECG, and echo (LAVI, LVEF) to clinical data improved event prediction (Figure) Conclusions: High risk diabetic subjects may be correctly risk stratified integrating sequentially clinical data with NTproBNP, ECG, and echocardiogram

scholarly journals ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2019 ◽  
pp. 61-63
Author(s):  
PRUDENCE A RODRIGUES ◽  
SOUMYA GK ◽  
NADIA GRACE BUNSHAW ◽  
SARANYA N ◽  
SUJITH K ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Injury ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Loop Diuretics ◽  
Contributing Factors ◽  
The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

scholarly journals A modern view of the place of b-blockers in the treatmentof cardiovascular disease: the choice of drug within a class is crucial

2015 ◽  
Vol 12 (4) ◽  
pp. 69-74
Author(s):  
O D Ostroumova ◽  
V M Fomina ◽  
E A Smolyarchuk
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Chronic Heart Failure ◽  
Arterial Hypertension ◽  
Clinical Studies ◽  
Metoprolol Succinate ◽  
Selection Of

In the article discusses questions of application of b-blockers (b-AB) for the treatment of arterial hypertension, coronary heart disease, chronic heart failure. The data from modern Russian and European recommendations about the place of b-AB in the treatment of cardiovascular diseases. Analyzed in detail the selection of b-AB inside the class from the standpoint of pharmacokinetics, selectivity, study in clinical studies. Data about efficiency and safety of application of metoprolol succinate for the treatment of arterial hypertension, coronary heart disease, chronic heart failure.

P765One-year mortality risk after intensification of outpatient diuretics

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Madelaire ◽  
F Gustafsson ◽  
S L Kristensen ◽  
L W Stevenson ◽  
L Koeber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Risk ◽  
Angiotensin Receptor Blocker ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Outpatient Setting ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
One Year

Abstract Background Mortality is increased following a hospitalization for heart failure (HF). It is not clear whether outpatient intensification of diuretic confers the same increased risk in the general population with heart failure Purpose This study sought to assess 1-year mortality risk after worsening HF, defined either as hospitalization due to HF or as intensified diuretic therapy in an outpatient setting, in a complete nationwide cohort of patients with HF on angiotensin converting enzyme inhibitors/ angiotensin receptor blocker and beta blockers. Methods From nationwide administrative registers, we identified all patients in Denmark diagnosed with HF in 2001–2016 and prescribed angiotensin converting enzyme inhibitor/ angiotensin receptor blocker and beta blocker within 120 days. During follow-up we defined worsening HF by the following events: Inpatient worsening (HF readmission) and outpatient worsening (intensified diuretic therapy, defined as the first event of new addition or doubled dosage of loop diuretic therapy or new onset addition of thiazide to loop diuretic therapy). Patients with a worsening event were risk set matched to two HF controls each at time of the event – based on age, sex and calendar year. One-year mortality risk was estimated with Kaplan-Meier and multivariable Cox regression models. Results We included 74,990 patients, median age 71 years (interquartile range: 62–79), 36% women. During five years of follow up, 8,727 patients had an inpatient worsening event, and 12,290 had an outpatient worsening event as first event. Absolute risk of 1-year mortality was 22.6% (95%-confidence interval (95%-CI): 21.7%-23.5%) after inpatient worsening, 18.0% (95%-CI: 17.3%-18.7%) after outpatient worsening compared to 9.8% (95%-CI: 9.5%-10.1%) for the matched controls. In a multivariable Cox model adjusted ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease and diabetes, the hazard ratio for mortality among patients experiencing inpatient worsening was 2.46 (95%-CI: 2.33–2.60) and for outpatient worsening was 1.87 (95%-CI: 1.77–1.97), compared with the matched HF controls as reference (figure 1). Among patients who had an outpatient worsening as first event, 1,245 (10.1%) had a subsequent HF readmission within one year. Conclusion In a nationwide cohort of patients with HF, outpatient worsening defined by a diuretic intensification was associated with almost 2-fold risk of mortality during the next year. Although HF hospitalization is associated with a higher risk, the need to intensify diuretics in the outpatient setting is a signal to review and intensify efforts to improve HF outcomes. Acknowledgement/Funding The Danish Heart Foundation, (grant number 17-R116-A7610-22048)

scholarly journals Relationship between metabolic syndrome components in patients with resistant arterial hypertension

2021 ◽  
Vol 11 (6) ◽  
pp. 199-208
Author(s):  
I. P. Shmakova ◽  
S. A. Panina ◽  
P. A. Shishova
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Arterial Hypertension ◽  
Density Lipoprotein ◽  
Resistant Arterial Hypertension

Metabolic syndrome (MS) is a complex of interrelated pathological conditions based on insulin resistance, obesity, dyslipoproteinemia, arterial hypertension (AH). MS is a predictor of the cardiovascular disease, type 2 diabetes mellitus (DM), cancer and premature death. The incidence of type 2 diabetes increases with age and is 25.2% among the elderly. The prevalence of prediabetes or metabolic syndrome was approximately three times higher. Heart failure is another important cause of morbidity and mortality from the cardiovascular disease. Recent studies have shown that the incidence of hospitalizations for heart failure (adjusted for age and gender) was twice as high in patients with diabetes compared with patients without diabetes. Patients with hypertension and abdominal obesity (AO) have an increased risk of various complications: type 2 diabetes -5-9 times, stroke - 7 times, coronary heart disease - 4 times and mortality - 2 times. Objective: To analyze the relationship between the components of the metabolic syndrome in patients with resistant arterial hypertension (RAH). Materials and methods. A retrospective analysis of case histories of 120 patients, including 52 men (43.33%) and 68 women (56.67%) with a diagnosis of RAH and signs of MS. The presence of concomitant pathology, the level of office arterial pressure, pulse pressure (PP) were calculated; body weight, height with calculation of body mass index (BMI); waist circumference (WC), the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL), triglycerides (TG), and plasma glucose were studied. Student's criterion was used to assess the degree of significance of the differences, p≤0.05 was taken as the critical level of significance. Pearson's correlation coefficient was used. Disorders of carbohydrate metabolism among patients with MS and RAH is 67.50%, of which type 2 diabetes makes 50.83%, impaired glucose tolerance - 16.67%. Patients with impaired carbohydrate metabolism are 2 times more likely to have complications of hypertension and lower HDL. Women with MS and RAH were significantly older than men and more often had concomitant pathology: morbid obesity (p <0.05), type 2 diabetes mellitus (p <0.05), chronic cerebral ischemia (p <0.05), higher body mass index (p <0.01). Strong correlation between WC and BMI (r = 0.707; p˂0.001), weak direct correlations between WC and PP (r = 0.231; p˂0.05) and WC and TG (r = 0.221; p˂0.05), weak feedback between WC and age (r = -0.188; p˂0.05), and for men direct correlations between WC and TG were confirmed (r = 0.454; p˂0.001), BMI and TG (r = 0.454, p˂0.002).

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