To access this material please log in or register

Register Authorize

Study for comparative evaluation of Trigrim and Arifon Retard efficacy and safety in patients with arTerial hypertension in a parallel group, blind, randomized study (study START)

Sviryaev Yu. V., Zvartau N. E., Korostovtseva L. S., Semenov A. P., Konradi A. O.
Federal State Budgetary Institution “V. A. Almazov Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: arterial hypertension, diuretics, treatment

DOI: 10.18087/rhj.2014.6.2017

Background. Diuretics are almost the oldest class of drugs used for treatment of arterial hypertension (AH). Generally, the antihypertensive therapy with diuretics includes thiazide and / or thiazide-like diuretics. However, some recent studies have demonstrated efficacy of loop diuretics for the treatment of AH. Aim. To compare efficacy of torasemide (Trigrim) and indapamide retard (Arifon Retard) in patients with grade 1–2 AH in a blind randomized study. Materials and methods. The study included 60 patients with grade 1–2 AH, 48 men and 12 women (mean age, 52±15). The study was blind, and codes were disclosed after the study completion. Standardized therapy implied titration of torasemide dose at the third of four visits; the highest torasemide dose was 5 mg / day and the highest indapamide retard dose was 1.5 mg. Efficacy endpoints were decreased systolic BP (SBP) and diastolic BP (DBP) below 140 / 90 mm Hg in office measurement and below 130 / 80 mm Hg in 24‑h BP monitoring (24‑h BPM). Prior to the treatment onset and until the study completion, clinical and laboratory-instrumental examinations were performed. Treatment period was 12 weeks. Results. Comparative analysis performed after the study completion and treatment code disclosure showed that the treatment with loop diuretic, torasemide effectively reduced SBP and DBP compared to baseline values in «office» measurement (10.7 and 8.8 %, respectively). The torasemide treatment was associated with decreased SBP (from 149.6±9.9 to 134±6.3 mm Hg, p<0.01) and DBP (from 90.5±3.6 to 83±5.3 mm Hg, p<0.01). According to self-monitoring diaries, office SBP and DBP were reducing faster in patients receiving torasemide. Conclusion. The treatment of grade 1 and 2 AH patients with the loop diuretic, torasemide in the comparative, blind, randomized study, effectively reduced SBP and DBP from baseline values, allowed faster achievement of target BP, and did not affect the lipid profile, glycemia, and electrolyte levels. Therefore, this treatment can be recommended for more extensive use in combination therapy for AH and in patients of special groups (isolated systolic AH and elderly).
  1. Chobanian AN, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. 2003;289 (19):2560–72.
  2. Arterial hypertension. Report of a WHO expert committee. World Health Organ Tech Rep Ser. 1978:7–56.
  3. Luft FC. Torasemide in the treatment of arterial hypertension. J Cardiovasc Pharmacol. 1993;22 (Suppl 3):S32–9.
  4. Spannbrucker N, Achhammer I, Metz P et al. Comparative study on the antihypertensive efficacy of torasemide and indapamide in patients with essential hypertension. Drug Res. 1988;38 (1):190–3.
  5. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH / ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013 Jul 21;34 (28):2159–219.
  6. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311 (5):507–20.
  7. Brien E, Asmar R, Beilin L, Imai Y et al. Practice guidelines of the European society of hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005 Apr;23 (4):697–701.
  8. Achhammer I, Metz P. Low dose loop diuretics in essential hypertension. Experience with torasemide. Drugs. 1991;41 (Suppl 3): 80–91.
  9. Dodion L, Ambroes Y, Lameire N. A comparison of the pharmacokinetics and diuretic effects of two loop diuretics, torasemide and furosemide, in normal volunteers. Eur J Clin Pharmacol. 1986;31 (Suppl): 21–7.
  10. Achhammer I, Eberhard R. Comparison of serum potassium levels during long-term treatment of hypertension patients with 2,5 mg torasemide o.d. or 50 mg triamterene / 25 mg hydrochlorothi-azide o.d. In: Progress in Pharmacology and Clinical Pharmacology. – Gustav-Fischer-Verlag: Stuttgart – 1990;8:211–20.
  11. Stergiou GS, Baibas NM, Gantzarou AP et al. Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy. Am J Hypertens. 2002 Feb;15 (2 Pt 1):101–4.
  12. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension. Cardiovasc Drugs Ther. 1993 Jan;7 (Suppl 1):63–8.
  13. Boelke T, Piesche L. Influence of 2,5–5 mg torasemide o.d. versus 25–50 mg HCTZ / 50–100 triamterene o.d. on serum parameters in elderly patients with mild to moderate hypertension. In: Diuretics IV: Chemistry, Pharmacology and clinical Applications. – Excerpta Medica: Amsterdam. – 1993; 279–82.
  14. Werner U, Werner D, Heinbuchner S et al. Gender is an important determinant of the disposition of the loop diuretic torasemide. J Clin Pharmacol. 2010;50 (2):160–8.
  15. Girerd X, Giannattasio C, Moulin C et al. Regression of radial artery wall hypertrophy and improvement of carotid artery compliance after long-term antihypertensive treatment in elderly patients. J Am Coll Cardiol. 1998;31 (5):1064–73.
  16. Mackenzie IS, McEniery CM, Dhakam Z et al. Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension. Hypertension. 2009 Aug;54 (2):409–13.
  17. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12‑yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993 Feb; 16 (2):434–44.
  18. Whelton PK, Barzilay J, Cushman WC et al. Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005;165 (12):1401–9.
  19. Reyes AJ, Chiesa PD, Santucci MR et al. Hydrochlorothiazide versus a nondiuretic dose of torasemide as once daily antihyper-tensive monopharmacotherapy in elderly patients; randomized and double-blind study. In: Progress in Pharmacology and Clinical Pharmacology. – Gustav-Fischer-Verlag: Stuttgart – 1990;8:183–209.
  20. Cosin J, Diez J. Torasemide in chronic heart failure: Results of the TORIC study. Eur J Heart Fail. 2002;4 (4):507–13.
  21. Ткачева О. Н., Шарашкина Н. В., Новикова И. М., Чухарева Н. А. Сравнительное исследование эффектов торасемида и гипотиазида в комбинированном лечении гипертонической болезни у женщин в период постменопаузы. Сердце. 2011;103:156–60.
Sviryaev Yu. V., Zvartau N. E., Korostovtseva L. S. et al. Study for comparative evaluation of Trigrim and Arifon Retard efficacy and safety in patients with arTerial hypertension in a parallel group, blind, randomized study (study START). Russian Heart Journal. 2014;13 (6):389–395

To access this material please log in or register

Register Authorize
Ru En