Anticipated diuretic clinical outcomes by cardiologists worldwide Cold water

The diuretic chlorthalidone, whose recommendation has been upgraded due to its cardiovascular disease prevention effect and long half-life, is expected to be discontinued.

As a result of large-scale clinical trials, the incidence of cardiovascular events was similar to hydrochlorothiazide, the current drug, and kidney damage and hypokalemia with chlorthalidone, making it inevitable to rethink the recommended grade.

Torsemide, a loop diuretic for heart failure patients, also showed no significant difference in mortality and hospitalization rates compared to furosemide.

The results of this study were presented at the annual scientific conference of the American Heart Association (AHA) to be held from the 5th to the 7th local time in Chicago, USA.

The American Heart Association Science Session was held in Chicago, USA from the 5th to the 7th local time.

Recently, diuretics prescribed for hypertensive patients have shifted emphasis from thiazide to chlorthalidone. Since chlorthalidone has a relatively long half-life and cardiovascular protective effect, its importance has been expanded in domestic and foreign major hypertension drug treatment guidelines.

In fact, last year, the Korean Society of Clinical Hypertension issued a guideline for the treatment of hypertension, saying, “Recently, the market for thiazide-type diuretics is gradually narrowing.” It is longer and there is a clear benefit in the prevention. cardiovascular disease, so recent medical guidelines recommend the use of chlorthalidone.”

On the other hand, this effect was not reproduced in the new DCP clinical trial.

Researchers such as AREEF Ishani of the Minneapolis VA Medical System conducted clinical trials on 13,500 US veterans age 65 or older. After identifying patients who received hydrochlorothiazide among the participants, they were randomly assigned to either continue with the conventional drug or switch to the equivalent dose of chlorthalidone. Incidence rates of primary events such as myocardial infarction (MI), stroke, non-cancer death, acute heart failure hospitalization, and acute vascular revascularization were compared during an average follow-up of 2.4 years.

As a result of the analysis, there was no difference in blood pressure control, and the primary composite outcome of MI, stroke, non-cancer death, acute heart failure hospitalization, or urgent revascularization was 10.4% in the chlorthalidone group and 10.0% in the hydrochlorothiazide group (HR 1.04) There were no differences in clinical events. Secondary outcomes set to all-cause mortality, revascularization, or erectile dysfunction were also not different.

Regarding side effects, chlorthalidone was associated with increased hypokalemia (6% vs. 4.4%, HR 1.38), but there was no difference in hospitalization rates for acute kidney injury.

Professor Ishani, who led the study, said, “Because clinicians usually have an idea that chlorthalidone is more potent, clinical trials also expected that chlorthalidone would be effective in general, but I was surprised that it was not. I can say yes,” he added.

Meanwhile, the position of torsemide, which had a comparative advantage in the comparison between the loop diuretics torsemide and furosemide, was being compromised.

This is because a study has shown that the risk of survival or readmission is similar between furosemide and torsemide when loop diuretics are given in patients hospitalized for heart failure (HF).

People with heart failure experience a significant increase in body fluid which can cause swelling as well as difficulty breathing. Loop diuretics differ from general diuretics in that they prevent the kidneys from reabsorbing water and sodium.

The TRANSFORM-HF clinical study conducted by researchers including Robert J. Mentz at Duke University in the United States was designed to identify a suitable loop diuretic in elderly patients with heart failure.

After 1 to 1 randomization of 2859 heart failure patients recruited from 60 US medical institutions regardless of cardiac output, torsemide (n=1431) and furosemide (n=1428) were compared to one side all-cause deaths and all-cause hospital admissions.

Follow-up was done through the call center at 30 days, 6 months, and 12 months after discharge. There was no significant difference in the effects on mortality and hospitalization rates during the mean follow-up period of 17.9 months.

Professor Robert Mentz said, “In clinical trials, torsemide did not show better results.

“But now that the debate between the two drugs has been resolved, doctors can focus on more patient-centred treatment,” he said. “We can focus on doubling our efforts on treatment,” he added.

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