Central'naya gorodskaya klinicheskaya bol'nica №3 g. Doneck Minzdrava DNR
The aim of study was to assess torasemide and indapamide effects on magnesium (Mg), potassium (K), calcium (Ca), and sodium (Na) excretion in postmenopausal women with hypertension and heart failure with preserved ejection fraction (HFpEF) depending on Mg exchange. Material and methods. 140 postmenopausal women with hypertension and HFpEF were examined. Based on Mg-tolerance test results, patients were divided into 2 groups: with (n = 72) and without Mg deficiency (n = 68) with randomization into 4 subgroups: 1a, 1b – 36 patients and 2a, 2b - 34 women in each. Subgroups 1a and 2a received torasemide 5 mg, 1b and 2b – indapamide 2.5 mg. Daily diuresis, Na, K, Ca and Mg excretion were determined before and after diuretics use. Results. Diuretics caused equal (p>0.05) increase (p<0.001) in daily urine output and natriuresis by 561 (95%CI: 556–571) ml and 71.0 (95%CI: 68.9– 73.1) mmol/24h. K excretion increased (p<0.0001) only with indapamide use by 21.1 (95% CI: 18.4-23.8) mmol / 24h and 22.3 (95% CI: 19.5-25.0) mmol / 24h in groups 1b and 2b. Mg excretion increase was not detected (p>0.05) only in patients with Mg deficiency torasemide subgroup, but Ca loss remained unchanged (p>0.05) in indapamide subgroups. K/Na and Ca/Na ratio decreased in all groups, while Mg/Na increased with indapamide use and decreased with torasemide use. Torasemide decreased (p<0.001) Mg/Ca excretion ratio, but indapamide decreased (p<0,0001) the one. Conclusion. Indapamide caused significant increase in K, Mg excretion and Mg/Ca, while torasemide increased Ca loss, decreased Mg/Ca, and did not affect K loss in postmenopausal women with hypertension, HFpEF regardless to Mg deficiency. Torasemide did not lead to Mg losses increase in macronutrient-deficiency patients.
hypertension; chronic heart failure; torasemide; indapamide; magnesium; calcium; potassium; sodium
1. Williams B., Mancia G., Spiering W. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal. 2018;39(33):3021–104. doi:10.1093/eurheartj/ehy339.
2. Ponikowski P., Voors A. A., Anker S. D. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2016;27(37):2129–2200. doi:10.1093/eurheartj/ ehw128.
3. Karpov Yu. A. Torasemid: rekomendacii dlya klinicheskogo primeneniya pri hronicheskoy serdechnoy nedostatochnosti i arterial'noy gipertenzii. RMZh. 2014; 23(22):1676-1680.
4. Burnier M., Bakris G., Williams B. Redefining diuretics use in hypertension: why select a thiazide- like diuretic? J Hypertens. 2019;37(8):1574-1586. doi:10.1097/HJH.0000000000002088
5. Alexander R. T., Dimke H. Effect of diuretics on renal tubular transport of calcium and magnesium. Am J Physiol Renal Physiol. 2017;312(6):998-1015. doi:10.1152/ajprenal.00032.2017.
6. Grcber U., Schmidt J., Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015;7(9):8199- 8226. doi:10.3390/nu7095388.
7. Rosanoff A., Dai Q., Shapses S. A. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Status Interact with Vitamin D and/ or Calcium Status? Adv Nutr. 2016;7(1):25-43. doi:10.3945/an.115.008631.
8. Maylyan D. E., Kolomiec V. V. Sostoyanie obmena kal'ciya, pokazateli sutochnogo monitorirovaniya arterial'nogo davleniya i arterial'noy zhestkosti na fone deficita magniya u zhenschin postmenopauzal'nogo vozrasta s arterial'noy gipertenziey i hronicheskoy serdechnoy nedostatochnost'yu. Rossiyskiy kardiologicheskiy zhurnal. 2020;25(12):3984. doi:10.15829/1560-4071-2020-3984.
9. Coe F. L., Worcester E. M., Evan A. P. Idiopathic hypercalciuria and formation of calcium renal stones. Nat Rev Nephrol. 2016;12(9):519-533. doi:10.1038/ nrneph.2016.101.
10. Blaine J., Chonchol M., Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol. 2015;10(7):1257-1272. doi:10.2215/ CJN.09750913.
11. Grcber U. Magnesium and Drugs. Int J Mol Sci. 2019;20(9):2094. doi:10.3390/ijms20092094.
12. Balsam P., Ozierański K., Tymińska A. The impact of torasemide on haemodynamic and neurohormonal stress, and cardiac remodelling in heart failure - TORNADO: a study protocol for a randomized controlled trial. Trials. 2017;18(1):36. doi:10.1186/ s13063-016-1760-z.
13. Knauf H., Mutschler E., Velazquez H., Giebisch G. Torasemide significantly reduces thiazide-induced potassium and magnesium loss despite supra-additive natriuresis. Eur J Clin Pharmacol. 2009;65(5):465-472. doi:10.1007/s00228-009-0626-7.
14. Villa-Bellosta R. Impact of magnesium:calcium ratio on calcification of the aortic wall. PLoS One. 2017;12(6):e0178872. doi:10.1371/journal. pone.0178872.
