gms | German Medical Science

Objective: Thiazides are considered beneficial in the elderly suffering from congestive heart failure (CHF), even though they often are associated with side-effects like hypokalemia. For loop-diuretics like torasemide, a well tolerated high-ceiling long-acting loop-diuretic, the positive correlation of therapeutic benefit with high age has not been shown up to date. We, therefore, investigated the influence of age on the therapeutic response of torasemide in CHF.

Methods: In this multicenter observational open label study in an outpatient setting, 2,878 patients suffering from cardiovascular diseases (median age 68.3 years, 53.4% women) were enrolled. Of these, 2,286 suffered from CHF. Patients were conferred to torasemide (median dose 10.0 mg/d) with a 6-weeks follow-up. In CHF-patients, NYHA-grade was documented by the treating physician before torasemide treatment and at follow-up.

Results: After 6 weeks of treatment with torasemide, more than half of the patients improved according to their NYHA-grade. This amelioration was more pronounced the elder the patient was:

(Table 1 [Tab. 1])

Conclusion: In this study, the therapy with torasemide resulted in a pronounced improvement in NYHA-grade. The improvement correlates positively with the age of patients. Interestingly, the use of torasemide, in contrast to thiazides, is not limited by the glomerular filtration rate, which diminishes at increasing age. Further, at low doses as used in this study, torasemide is not likely to cause hypokalemia, a risk factor for cardiac mortality, whereas thiazides are associated with potassium losses. Torasemide might thus be superior to thiazides in terms of treating elderly patients suffering from congestive heart failure.