Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV -: efficacy and quality of life

Background: The hypothesis was that torasemide, due to more predictable pharmacokinetics/pharmacodynamics, induces greater improvements in functional and social limitation than furosemide and reduces the frequency of hospitalisations in primary care patients with chronic heart failure (CHF). Patients and Methods: Prospective, randomized, unblinded study in primary care, 237 patients with CHF (NYHA II-IV), all on ACE inhibitors. Randomisation: torasemide (n = 122) or furosemide (n = 115), treated for 9 months. Endpoints: Clinical efficacy, quality of life, safety, tolerability, hospitalisations. Results: Clinical improvement was observed in both groups, but the trend to improve by at least one NYHA class was significant only in torasemide- (P=0.014), but not in furosemide-treated patients. There were no differences with regard to adverse events and hospitalisation due to CHF. Overall, tolerability (P = 0.0001) and improvement in daily restrictions (P = 0.0002) were significantly higher, number of mictions at 3, 6 and 12 h after diuretic intake (P < 0.001 at all time points) and urgency to urinate (P < 0.0001) significantly lower in torasemide- vs. furosemide-treated patients. Conclusion: CHF patients treated with torasemide gain a higher benefit in quality of life than furosemide treated patients, due to torasemide's dual effect on both clinical status and social function. (C) 2003 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved.