Short-term efficacy of tolvaptan combined with torasemide in treatment of elderly patients with heart failure

doi:10.3877/cma.j.issn.1674-0785.2017.21.002

Abstract

Abstract:

Objective

To observe the short-term efficacy and safety of tolvaptan combined with torasemide in treating elderly patients with heart failure.

Methods

Ninety aged patients with heart failure treated at the First Hospital of Shanxi Medical University in 2016 were retrospectively selected and divided into a torasemide group, a tolvaptan group, and a combination group, with 30 cases in each group. All patients were regularly treated with vasodilator, RAAS inhibitors, beta-blockers and so on. Besides, the torasemide group was given torasemide 40 mg/d, the tolvaptan group was treated with tolvaptan 15 mg/d, and the combination group was treated with tolvaptan 15 mg/d and torasemide 20 mg/d. After 5 days of treatment, we observed the improvement of heart failure symptoms and the changes of cardiac and renal function indexes such as 24 h urine output, electrolytes, N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), renal resistive index (RRI), cystatin C (Cys-C), and uric acid (UA).

Results

After treatment, heart failure symptoms were significantly improved in all the three groups of patients. Compared with the torasemide group, heart failure symptoms of patients in the tolvaptan group and combination group improved significantly (P<0.05), although there was no significant difference between the tolvaptan group and combination group (P>0.05). Compared with the torasemide group, 24 h urine volume, serum sodium, and eGFR in the tolvaptan group and combination group increased significantly, and NT-proBNP, UA, Cys-C, and RRI levels significantly decreased (P<0.05). Compared with the tolvaptan group, 24 h urine volume of patients in the combination group increased significantly, and the level of NT-proBNP significantly decreased (P<0.05), while there was no significant difference in serum sodium, serum potassium, UA, Cys-C, RRI, or eGFR (P>0.05).

Conclusion

The combination of tolvaptan and torasemide is effective in elderly patients with heart failure and can significantly increase serum sodium concentration and reduce the risk of kidney injury with good safety. In addition, the combination treatment can shorten hospitalization duration.

Key words: Tolvaptan, Heart failure, Cardiac function, Renal function

Ting Liu, Aimei Sun, Huanzhen Chen. Short-term efficacy of tolvaptan combined with torasemide in treatment of elderly patients with heart failure[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(21): 2357-2361.

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References 15

[1]	赵树梅,沈璐华. 老年患者心力衰竭的临床特点[J]. 中华老年多器官疾病杂志, 2014, 13(9): 656-659.
[2]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南[J]. 中华心血管病杂志, 2014, 42(2): 98-99.
[3]	Bettari L,Fiuzat M,Shaw L, et al. Hyponatremia and long-term outomes in chronic heart failure-an observational study from the duke databank for cardiovascular diseases [J]. Cardiac Fail, 2012, 18(1): 74-81.
[4]	黄莺,张春红. 心力衰竭合并低钠血症患者的临床特征分析及其疗效观察[J]. 实用心脑肺血管病杂志, 2013, 21(4): 34-35, 40.
[5]	O′connell JB,Alemayehu A. Hyponatremia, heart failure, and the role of tolvaptan [J]. Postgrad Med, 2012, 124(2): 29-39.
[6]	韩瑾,陈还珍,黄静, 等. 托伐普坦治疗慢性心力衰竭的临床观察[J]. 中国现代医药杂志, 2016, 18(1): 35-37.
[7]	王士雯,吴海云. 老年人多病因心力衰竭:多种病因和合并疾病在老年人心力衰竭发生和发展中的作用[J]. 中华老年多器官疾病杂志, 2007, 6(6): 373-376.
[8]	Gill G,Huda B,Boyd A, et al. Characteristics and mortality of severe hyponatremia hospital-based study [J]. Clin Endocrinol, 2006, 65(2): 246-249.
[9]	Fillippatos TD,Elisaf MS. Hyponatremia in patients with heart failure [J]. World J Cardiol, 2013, 5(9): 317-328.
[10]	Renneboog B,Musch W,Vandemergel X, et al. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits [J]. Am J Med, 2006, 119(1): 71, e1-e8.
[11]	Romanovsky A,Bagshaw S,Rosner MH. Hyponatremia and congestive heart failure: A marker of increased mortality and a target for therapy [J]. Int J Nephrol, 2011, 11(4): 732-746.
[12]	Matsue Y,Suzuki M,Seya M, et al. Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population [J]. J Cardiol, 2013, 61(2): 169-174.
[13]	Kinugawa K,Sato N,Inomata T, et al. Efficacy and safety of tolvaptan in heart failure patients with volume overload [J]. Circ J, 2014, 78(4): 844-852.
[14]	Teruhiko I,Koichiro K,Shun M, et al. Third Place Urine Sodium Excretion After Tolvaptan Administration Is Dependent Upon Baseline Serum Sodium Levels [J]. Int Heart J, 2014, 55(2): 131-137.
[15]	Konstam MA,Gheorghiade M,Burnett JC, et al. Effects of oral tolvaptan in patientshospitalized for worsening heart failure: the EVEREST Outcome Trial [J]. JAMA. 2007, 297(12): 1319-31.

组别	例数	年龄（岁，±s）	男性	高血压	冠心病	扩心病	心功能Ⅳ级	低钠症	住院时间（d，±s）
托拉塞米组	30	72.07±7.74	16（53.3）	17（56.7）	15（50.0）	7（23.3）	16（53.3）	15（50.0）	14.03±1.61
托伐普坦组	30	71.23±8.28	15（50.0）	11（36.7）	17（56.7）	8（26.7）	15（5.00）	17（56.7）	10.13±2.15^a
联合用药组	30	71.53±8.17	14（46.7）	16（53.3）	16（53.3）	7（23.3）	13（43.3）	16（53.3）	8.37±1.16^ab
统计值	?	F=0.082	χ²=0.267	χ²=2.757	χ²=0.268	χ²=0.120	χ²=0.623	χ²=0.268	F=88.692
P值	?	0.901	0.875	0.252	0.875	0.942	0.733	0.875	<0.05

组别	例数	年龄（岁，±s）	男性	高血压	冠心病	扩心病	心功能Ⅳ级	低钠症	住院时间（d，±s）
托拉塞米组	30	72.07±7.74	16（53.3）	17（56.7）	15（50.0）	7（23.3）	16（53.3）	15（50.0）	14.03±1.61
托伐普坦组	30	71.23±8.28	15（50.0）	11（36.7）	17（56.7）	8（26.7）	15（5.00）	17（56.7）	10.13±2.15^a
联合用药组	30	71.53±8.17	14（46.7）	16（53.3）	16（53.3）	7（23.3）	13（43.3）	16（53.3）	8.37±1.16^ab
统计值	?	F=0.082	χ²=0.267	χ²=2.757	χ²=0.268	χ²=0.120	χ²=0.623	χ²=0.268	F=88.692
P值	?	0.901	0.875	0.252	0.875	0.942	0.733	0.875	<0.05

组别	例数	肺部啰音			呼吸困难			水肿
组别	例数	改善	无变化	恶化	改善	无变化	恶化	改善	无变化	恶化
托拉塞米组	30	20	7	3	19	6	5	20	8	2
托伐普坦组	30	27	2	1	26	3	1	27	2	1
联合用药组	30	28	1	1	28	1	1	28	1	1
H值	?	8.744			9.75			8.561
P值	?	0.013			0.008			0.014

组别	例数	肺部啰音			呼吸困难			水肿
组别	例数	改善	无变化	恶化	改善	无变化	恶化	改善	无变化	恶化
托拉塞米组	30	20	7	3	19	6	5	20	8	2
托伐普坦组	30	27	2	1	26	3	1	27	2	1
联合用药组	30	28	1	1	28	1	1	28	1	1
H值	?	8.744			9.75			8.561
P值	?	0.013			0.008			0.014

组别	例数	尿量（ml）		NT-proBNP（ng/L）		血钠（mmol/L）		血钾（mmol/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
拖拉塞米组	30	1032.67±117.94	2152.00±383.71	9146.60±3809.82	5345.30±3672.14	134.63±2.96	131.27±3.84	3.68±0.47	3.76±0.47
托伐普坦组	30	966.83±147.87	3029.00±415.82^a	9242.73±2914.64	3396.03±1871.46^a	134.67±3.04	141.37±2.81^a	3.62±0.47	3.62±0.47
联合用药组	30	1030.00±115.37	3591.33±374.01^ab	9141.77±2865.63	1785.17±914.22^ab	134.37±3.12	140.80±2.89^a	3.59±0.43	3.65±0.44
F值	?	2.546	102.943	0.009	16.049	0.088	93.426	0.291	0.291
P值	?	0.084	<0.05	0.991	<0.05	0.916	<0.05	0.748	0.748
组别	例数	尿酸（μmol/L）		Cys-C（mg/L）		eGFR[ml/（min?1.73m²）]		RRI
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
拖拉塞米组	30	325.63±57.94	?	457.87±40.65	1.19±0.13	1.01±0.09	80.80±5.71	78.62±6.53	0.62±0.03	0.77±0.03
托伐普坦组	30	330.17±65.58	?	328.30±62.09^a	1.20±0.11	0.82±0.03^a	81.08±5.98	94.95±3.13^a	0.64±0.03	0.63±0.02^a
联合用药组	30	332.17±62.80	?	322.87±56.47^a	1.20±0.13	0.82±0.03^a	80.95±6.06	95.24±3.03^a	0.62±0.03	0.62±0.03^a
F值	?	0.087	?	60.451	0.150	105.473	0.016	132.191	2.132	251.431
P值	?	0.917	?	<0.05	0.861	<0.05	0.984	<0.05	0.125	<0.05

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