Heart Failure Clinical Trial
Official title:
The Impact of TORasemide oN hemodynAmic and Neurohormonal Stress, and carDiac remOdeling in Heart Failure - Prospective, Randomized, Open, Blinded Endpoint Trial
The aim of the study is to compare the effects of torasemide and furosemide on clinical and
biochemical parameters of hemodynamic and neurohormonal compensation and myocardial
remodeling in patients with chronic heart failure with indications for use of loop
diuretics.
The study protocol 100 patients with heart failure NYHA (New York Heart Association) II-IV
(stable or exacerbation aligned cardiopulmonary at the time of enrollment, with a fixed-dose
loop diuretics]) treated with optimal medical therapy as clinically indicated for use loop
diuretics. Patients will be randomized to treatment with furosemide and torasemide
(randomization 1 : 1). After randomization, furosemide will continue in its current
fixed-dose or will be replaced by equipotential dose of torasemide (4:1). The minimal
follow-up of patients in the study will be at least six months.
According to current guidelines, angiotensin converting enzyme inhibitors and
beta-adrenolytics are the first-line treatment agents in patients with heart failure. In
case of fluid retention, diuretics, as a part of symptomatic treatment, should be
administered. In practice, the most common diuretic used in patients with heart failure is
loop diuretic - furosemide. What is important, furosemide has no effect on patients'
outcomes. Some studies showed unfavourable influence of this drug on
rennin-angiotensin-aldosterone system.
Alternative loop diuretic, which may be administered in patients with heart failure is
torasemide. Its longer elimination half-life time, similar diuretic effects, lower influence
on electrolyte disorders and additional pleiotropic effects could make torasemide more
beneficial than furosemide.
Accordingly, only direct comparison of furosemide and torasemide could present similarities
and differences of these two agents.
The hypothesis of this study is that torasemide may present more favourable effects on some
clinical parameters in patients with heart failure, than furosemide (e.g. clinical symptoms,
biochemical parameters, activity of rennin-angiotensin-aldosterone system, side effects).
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