Chronic
heart failure (CHF) is the cause of significant morbimortality all over the world and its incidence and prevalence are increasing. Fluid retention and volume overload are responsible of large part of morbility related to
heart failure. There are a variety of
therapy options for CHF, but
loop diuretics play an essential role.
Furosemide is the most commonly used
loop diuretic.
Torasemide is a loop
diuretic belonging to the
pyridine sulfonylurea class. It is a high-ceiling
diuretic that has a longer half-life, longer duration of action and higher bioavailability compared to
furosemide. It has additional actions such as antialdosterone and vasodilatation effects. It is the only
loop diuretic for which it has been shown to effectively lower
high blood pressure even with low doses. Thus,
torasemide is recommended for CHF treatment instead of
furosemide. Clinical trials have indicated that
torasemide improves left ventricular function, reduces mortality as well as the frequency and duration of
heart failure-related hospitalization. It also increases exercise tolerance, improves New York Heart Association functional classification and quality of life in patients with CHF. In addition,
torasemide is a very safe
drug. In a postmarketing surveillance study (TORIC) of 1,377 patients with CHF,
torasemide significantly reduced cardiovascular mortality in comparison to
furosemide.
Torasemide reversed myocardial
fibrosis and reduced
collagen type I synthesis, improving cardiac remodeling in patients with CHF.
Torasemide prolonged-release (PR) is a new formulation that, compared with
torasemide immediate-release, has a similar systemic exposure but significantly slower rates of absorption and lower fluctuations in plasma concentrations. Its natriuretic efficiency is higher and diuresis is more constant, with a better tolerability.