CIRCADIAN BLOOD PRESSURE PROFILE AND DIFFERENT DIURETIC THERAPY REGIMENS IN PATIENTS WITH SEVERE CHRONIC HEART FAILURE: EFFECTS ON NATRIURETIC PEPTIDE LEVELS

Abstract

Arterial hypotension, including orthostatic hypotension, is associated with cardiovascular morbidity and mortality risk in elderly patients. However, the prognostic role of orthostatic hypotension in chronic heart failure (CHF) is under-studied. This study aimed at comparing torasemide and furosemide effects on 24-hour blood pressure (BP) profile, BP level in orthostatic test, and brain natriuretic peptide (BNUP) level dynamics in patients with functional class (FC) III-IV CHF. The study included 40 patients with stable FC III-IV CHF and left ventricular ejection fraction (LVEF) <40% (Simpson); 90≤systolic BP≤140 mm Hg. Dynamics of clinical status, 6-minute walk test results, BNUP and aldosterone levels, quality of life (QoL), 24-hour BP monitoring (BPM), and active orthostatic test (OT) results was also assessed. All participants were randomised into two groups: one group (n=20) received torasemide (TG), and another group (n=20) was administered furosemide (FG). In patients with lower BP levels during 24-hour BPM and OT, higher levels of BNUP were registered. Lower BP levels affected the titration of the doses recommended for CHF treatment. In both groups, reduced CHF FC, decreased blood BNUP levels, and increased distance in a 6-minute walk test were observed. However, TG demonstrated higher BP levels and smaller BP drop in OT, which allowed using higher doses of beta-adrenoblockers (BAB) and increased QoL significantly. In patients with severe systolic CHF and substantial BP drop in OT, BNUP levels were higher. Switching from furosemide to torasemide helped to reduce orthostatic reaction, to optimise circadian BP profile, and to increase BAB doses in patients with Stable FC III-IV CHF.

Keywords

• arterial hypotension
• orthostatic hypotension
• chronic heart failure
• diuretics