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Effects of diuretics with different half-elimination times on changes in natriuresis and central hemodynamic parameters in patients with essential hypertension complicated with chronic heart failure

Arutyunov G. P.1, Dragunov D. O.1, Sokolova A. V.1, Morosanova E. I.2
1 - State Budgetary Educational Institution of Higher Professional Education, “N.I. Pirogov Russian National Research Medical University” of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997
2 – Federal State Budgetary Educational Institution of Higher Professional Education “M. V. Lomonosov Moscow State University”, Leninskie Gory 1, GSP-1, Moscow 119991

Keywords: hyperpiesis, diuretics, natriuresis, CHF, central hemodynamics

DOI: 10.18087/rhj.2014.2.1951

Background. Patients with AH complicated with CHF are known to have increased potassium reabsorption which leads to changes in natriuresis and central hemodynamic parameters. Aim. To study natriuresis and effects of diuretics with different half-elimination times on natriuresis changes and central hemodynamic parameters in patients with AH and CHF. Materials and methods. The study included 56 patients who were divided into 2 groups. Each group consisted of 28 patients receiving torasemid SR or IR 10 mg / day. Salt sensitivity was determined by the M. H. Weinberger method. Salt consumption was recorded using study-specific diaries and by natriuresis. Natriuresis was measured spectrophotometrically using MET-Cl-PC and MET-creatinine-PC test systems both in spot urine and 8 samples collected according to Zimnitsky. Sodium and potassium levels were measured with an electrolyte analyzer EASYLYTE Na / K. Arteriography was performed by applanation tonometry using a TensioClinic arteriograph. Results. Three types of 24h sodium excretion pattern were observed: isohyponatriuretic, hyponatriuretic and isonatriuretic types. The treatment with torasemid SR and torasemid IR was associated with statistically non-significant difference between areas under curves (SIR=13603.8 and SSR=13 741.2; р>0.05); however the torasemid SR treatment resulted in smooth, “peakless” natriuresis. Comparison of central hemodynamic parameters at baseline and at 30 days showed that these parameters were significantly improved in the torasemid SR treatment group (р <0.05), which indicated a statistically significant difference between central hemodynamic parameters. Comparison of the same parameters in the torasemid IR treatment group also showed their improvement but the difference was not statistically significant (р>0.05). Conclusion. Administration of a loop diuretic with a short half-elimination time is associated with peaky diuresis, which results in damage of renal tubules by large amounts of sodium.
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Arutyunov G. P., Dragunov D. O., Sokolova A. V. et al. Effects of diuretics with different half-elimination times on changes in natriuresis and central hemodynamic parameters in patients with essential hypertension complicated with chronic heart failure. Russian Heart Journal. 2014;76 (2):107–113

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