Diuretic therapy choice in the treatment of arterial hypertension and heart failure

Aim. То evaluate the diagnostic potential of the combination of 24-hour blood pressure and diuresis monitoring (CBPDM), to study the associations between diuresis and blood pressure (BP), to compare diuretic and antihypertensive activity of thiazide diuretics (tD) — hydrochlorothiazide (Hct) and loop diuretics (ID) such as furosem-ide and torasemide.

Material and methods. In 110 patients with arterial hypertension (AH) and congestive heart failure (HF), CBPDM was performed with 1-, 3-hour and functional intervals (morning, day, evening, and night), combined with a diuretic taken once a day: Hct, furosemide and torasemide (100, 20 and 5 mg/day, respectively).

Results. CBPDM demonstrated a strong correlation (r=0,5—0,75) between BP and diuresis in the patients examined. CBPDM with functional intervals was recommended for clinical practice use. CBPDM potential for circadian fluid and electrolyte metabolism and BP assessment, diuretic choice and effectiveness control was demonstrated. Torasemide benefits are related to its earlier, longer and more effective diuretic activity, as well as with lower risk of arterial hypotension.

Conclusion. CBPDM is an important method for studying renal mechanisms of HF and AH, diagnosing fluid metabolism disturbances, choosing diuretic therapy and controlling its effectiveness. Diuretic therapy choice should be based on fluid balance assessment, taking into consideration the benefits of a ID torasemide.

1. Рабочая группа по лечению артериальной гипертонии ЕОГ и ЕОК.

2. Рекомендации 2007 года по лечению артериальной гипертонии.

3. РФК 2008; 4(1-2): приложение: 2-76.

4. Диагностика и лечение хронической сердечной недостаточности. Национальные клинические рекомендации. Москва “Силицея-Полиграф” 2008; 146-221.

5. Patterson JH, Adams KF, Applefeld ММ, et al. for the Torasemide Invtstigators Group. Oral torasemide in patients with chronic congestive heart failure: tfftcts on body weight, edema and electrolyte excretion. Pharmacotherapy 1994;14(5):514—21.

6. Vargo DL, Kramer WG, Black PK, et al. Bioavailability, pharmacokinetics and pharmacodynamics of torasemide and furosemide in patients with congestive heart failure. Clin Pharmacol Ther 1995; 57(6): 601-9.

7. Функциональное состояние почек и прогнозирование сердечно-сосудистого риска.. Национальные клинические рекомендации. Москва “Силицея-Полиграф” 2008; 116-40.

8. Диагностика и лечение артериальной: гипертонии. Национальные клинические рекомендации. Москва ‘Силицея-Полиграф’ 2008; 20-56.

9. Authors/Task forse mtmbers. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Em Heart J 2008; 29: 2388-442.

10. Мухин H.A., Фомин В.В., С.В.Моисеев, М.С.Хамхоева. Хроническая сердечная недостаточность и поражение почек: перспективы лечения. Consmed 2008;10(9): 69—74.

11. Тареев Е.М. Нефриты. Москва “Медптз” 1958; 667 с.