Torasemide Has Beneficial Effects on Modulation of Sympathetic Nervous Activity Beyond Diuresis

1211, either, cat: 30

TORASEMIDE HAS BENEFICIAL EFFECTS ON MODULATION OF SYMPATHETIC NERVOUS ACTIVITY BEYOND DIURESIS

K. Harada1, H. Izawa1, A. Hirashiki1, Y. Murase1, H. Asano1, X.W. Cheng1, A. Noda2,

K. Nagata2, T. Murohara1, M. Yokota3

1Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Nagoya University School of Health Sciences, Nagoya, Japan, 3Aichi-Gakuin University Graduate School of Medicine, Japan

Background: Although a lower mortality among patients with chronic heart failure treated with torasemide, a loop diuretic with anti-aldosteronergic properties, compared to other diuretics have been reported, the mechanisms of the beneficial effect of torasemide remain to be fully elucidated.

Objectives: To determine the effect of torasemide, compared with azosemide, on activation of sympathetic nervous system (SNS) in mildly symptomatic patients with chronic heart failure (CHF).

Methods: Thirty patients with New York Heart Association functional class I or II received diuretic therapy with 8 mg/day oral torasemide (n = 15) or 30 mg/day oral azosemide (n = 15), in addition to their existing therapy for 3 months. We changed torasemide to azosemide or azosemide to torasemide and followed for another 3 months. We evaluated echocardiographic findings and plasma levels of neurohumoral factors at baseline and every 3-month.

Results: Torasemide significantly decreased left ventricular (LV) end-diastolic diameter from 53.2 +/- 8.2 to 50.6 +/- 8.9 mm (p< 0.01), and plasma levels of aldosterone from 135 +/- 64 to 88 +/- 43 pg/mL (p< 0.05). Torasemide did not affect plasma levels of norepinephrine. Conversely, azosemide significantly increased plasma levels of norepinephrine from 372 +/- 169 to 512 +/- 274 pg/mL (p< 0.01), without significant decrease in LV end-diastolic diameter.

Conclusion: This randomized, open-label, crossover study indicates that torasemide treatment can ameliorate LV remodeling without activation of SNS in patients with CHF as compared to azosemide. Anti-aldosteronergic properties in torasemide could play a role partly in favorable effects of torasemide.