Effect of torasemide in monotherapy or associated to other antihypertensive drugs on pulse pressure in essential hypertension

pulse pressure (PP) has been recognized as an independent prognostic factor of cardiovascular mortality and morbidity. Therefore, antihypertensive treatment should be effective in reducing PP to optimize cardiovascular prevention. to analyze the effect of torasemide 5–10 mg od alone or in combination with other antihypertensive non-diuretic drugs on PP after 6 month of treatment, in patients with mild-to-moderate essential hypertension (EH). multicenter, prospective, open study in newly diagnosed EH or patients not controlled by antihypertensive drugs other than diuretics in monotherapy (SBP between 140–180 mmHg and DBP between 90–110 mmHg). Never treated EH started with torasemide 5 mg (dose was titrated to 10 mg if BP higher than 140/90 mmHg after 6 and 12 weeks) whereas in previously treated and uncontrolled EH torasemide 2.5 mg was associated. Primary end point was PP reduction. 5102 EH were included in the study (mean age 61±11 years, 45% men), 40% aged 65 or more, and 65.4% with BMI > 27 Kg/m2. Most patients were treated uncontrolled (n=2728; 53.9%), and 46.1 % (n= 2336) were newly diagnosed. Baseline average SBP/DBP values were 159.8±9.1/ 96.3±4.4 mmHg. After 6 months, torasemide treatment significantly reduced BP to 137.7±9.4/ 81.9±6.1 mmHg (p< 0,001). Pulse pressure was reduced from 63.5±9.3 mmHg to 55.9±8.6 mmHg (p< 0,001) in the whole group. In both gender PP significantly correlated to age,and the highest PP values were observed in patients up to 65 years whereas the lowest PP values were observed in younger patients (65.4±9.4 vs 59.0±89. mmHg). PP reductions were higher in elderly patients, with no differences between men and women. Torasemide achieved strict BP control (BP< 140/90) in 53.6% of patients and the response rate (BP reduction > 10 mmHg) was 78.4%. At the end of the 6 month treatment period 63.3% were being treated with torasemide in monotherapy (75.5% with 10 mg) and 35.4% in combination (87.7% with 5 mg). Clinical adverse effects related to treatment were only reported in 20 patients, and 10 of them discontinued the study for this reason. We conclude that torasemide treatment 5–10 mg od in single therapy or associated to other antihypertensive drugs significantly reduced PP and cardiovascular risk of these patients.