META-ANALYSIS
Efficacy of torsemide versus furosemide in heart failure: a systematic review and meta-analysis
of randomized controlled trials
1
Department of Cardiology, Rochester Regional Health, Rochester, NY, USA
2
Division of Cardiology, Oregon Health and Science University, Portland, Oregon, USA
3
Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
4
Department of Pharmacy, University of Rochester, Rochester, New York, USA
5
Division of Internal Medicine, NYC Health + Hospitals/ Jacobi Medical Center, Albert Einstein College Medicine, Bronx, New York, USA
6
Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
7
University of Texas Medical Branch, Texas, USA
Submission date: 2025-03-17
Final revision date: 2025-08-30
Acceptance date: 2025-09-10
Publication date: 2026-03-30
Arch Med Sci Atheroscler Dis 2026;11(1):45-52
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Loop diuretics are a cornerstone in the symptomatic management of heart failure. There is conflicting evidence regarding potential differences between torsemide and furosemide in their effects on heart failure outcomes. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the therapeutic efficacy of furosemide versus torsemide in the management of heart failure.
Methods:
Medline/PubMed, Embase, and Cochrane Central Register of Controlled Trials were queried for studies comparing furosemide to torsemide in heart failure from inception to January 2023. Outcomes of interest included all-cause mortality, hospitalization due to heart failure, and weight change.
Results:
Our analysis included 10 RCTs comprising 4011 patients, of whom 2019 were treated with furosemide and 1992 patients were treated with torsemide. There was no significant difference between the groups in terms of all-cause mortality (OR = 0.99; 95% CI: 0.97–1.02; p = 0.66; I2 = 0.03%) or heart failure hospitalization (OR = 0.96; 95% CI: 0.87–1.06; p = 0.38; I2 = 89%). Both diuretics had a significant effect on weight change: torsemide (mean difference 2.36; 95% CI: 0.5–4.22; p = 0.01; I2 = 0.0%) and furosemide (mean difference 2.48; 95% CI: 0.81–4.15; p = 0.00; I2 = 0.0%). There was no significant difference in weight change between the two diuretics (mean difference –0.15; 95% CI: –0.82–0.52; p = 0.66; I2 = 94%).
Conclusions:
Furosemide and torsemide have similar impacts on mortality, hospitalization due to heart failure, and weight change in patients with congestive heart failure.
Loop diuretics are a cornerstone in the symptomatic management of heart failure. There is conflicting evidence regarding potential differences between torsemide and furosemide in their effects on heart failure outcomes. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the therapeutic efficacy of furosemide versus torsemide in the management of heart failure.
Methods:
Medline/PubMed, Embase, and Cochrane Central Register of Controlled Trials were queried for studies comparing furosemide to torsemide in heart failure from inception to January 2023. Outcomes of interest included all-cause mortality, hospitalization due to heart failure, and weight change.
Results:
Our analysis included 10 RCTs comprising 4011 patients, of whom 2019 were treated with furosemide and 1992 patients were treated with torsemide. There was no significant difference between the groups in terms of all-cause mortality (OR = 0.99; 95% CI: 0.97–1.02; p = 0.66; I2 = 0.03%) or heart failure hospitalization (OR = 0.96; 95% CI: 0.87–1.06; p = 0.38; I2 = 89%). Both diuretics had a significant effect on weight change: torsemide (mean difference 2.36; 95% CI: 0.5–4.22; p = 0.01; I2 = 0.0%) and furosemide (mean difference 2.48; 95% CI: 0.81–4.15; p = 0.00; I2 = 0.0%). There was no significant difference in weight change between the two diuretics (mean difference –0.15; 95% CI: –0.82–0.52; p = 0.66; I2 = 94%).
Conclusions:
Furosemide and torsemide have similar impacts on mortality, hospitalization due to heart failure, and weight change in patients with congestive heart failure.
REFERENCES (26)
1.
Crespo-Leiro MG, Metra M, Lund LH, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20: 1505-35. .
2.
Benjamin EJ, Muntner P, Bittencourt MS. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019; 139: e56-528.
3.
Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev 2017; 3: 7-11.
4.
Ellison DH. Diuretic drugs and the treatment of edema: from clinic to bench and back again. Am J Kidney Dis 1994; 23: 623-43. .
5.
Khan MS, Greene SJ, Hellkamp AS, et al. Diuretic changes, health care resource utilization, and clinical outcomes for heart failure with reduced ejection fraction: from the change the management of patients with Heart Failure Registry. Circ Heart Fail 2021; 14: e008351.
6.
Hammarlund MM, Paalzow LK, Odlind B. Pharmacokinetics of Furosemide in man after intravenous and oral administration. Application of moment analysis. Eur J Clin Pharmacol 1984; 26: 197-207.
7.
Huang X, Dorhout Mees E, Vos P, Hamza S, Braam B. Everything we always wanted to know about Furosemide but were afraid to ask. Am J Physiol Renal Physiol 2016; 310: F958-71.
8.
Tsutamoto T, Sakai H, Wada A, et al. Torasemide inhibits transcardiac extraction of aldosterone in patients with congestive heart failure. JACC 2004; 44: 2252-3.
9.
Peters AE, Mentz RJ, DeWald TA, Greene SJ. An evaluation of torsemide in patients with heart failure and renal disease. Expert Rev Cardiovasc Ther 2022; 20: 5-11.
10.
Buggey J, Mentz RJ, Pitt B, et al. A reappraisal of loop diuretic choice in heart failure patients. Am Heart J 2015; 169: 323-33.
11.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.
12.
López B, Querejeta R, González A, Sánchez E, Larman M, Díez J. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol 2004; 43: 2028-35.
13.
Müller K, Gamba G, Jaquet F, Hess B. Torasemide vs. Furosemide in primary care patients with chronic heart failure NYHA II to IV--efficacy and quality of life. Eur J Heart Fail 2003; 5: 793-801. .
14.
Han LN, Guo SL, Lin XM, et al. Torasemide reduces dilated cardiomyopathy, complication of arrhythmia, and progression to heart failure. Genet Mol Res 2014; 13: 7262-74. .
15.
Noe LL, Vreeland MG, Pezzella SM, Trotter JP. A pharmacoeconomic assessment of torsemide and Furosemide in the treatment of patients with congestive heart failure. Clin Ther 1999; 21: 854-66. .
16.
Yamato M, Sasaki T, Honda K, et al. Effects of torasemide on left ventricular function and neurohumoral factors in patients with chronic heart failure. Circ J 2003; 67: 384-90.
17.
Murray MD, Deer MM, Ferguson JA, et al. Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure. Am J Med 2001; 111: 513-20.
18.
Kasama S, Toyama T, Hatori T, et al. Effects of torasemide on cardiac sympathetic nerve activity and left ventricular remodelling in patients with congestive heart failure. Heart 2006; 92: 1434-40. .
19.
TORAFIC Investigators Group. Effects of prolonged-release torasemide versus Furosemide on myocardial fibrosis in hypertensive patients with chronic heart failure: a randomized, blinded-end point, active-controlled study. Clin Ther 2011; 33: 1204-13.e3.
20.
Mentz RJ, Anstrom KJ, Eisenstein EL, et al.; TRANSFORM-HF Investigators. Effect of torsemide vs furosemide after discharge on all-cause mortality in patients hospitalized with heart failure: the TRANSFORM-HF randomized clinical trial. JAMA 2023; 329: 214-23. .
21.
Trippel TD, Van Linthout S, Westermann D, et al. Investigating a biomarker-driven approach to target collagen turnover in diabetic heart failure with preserved ejection fraction patients. Effect of torasemide versus Furosemide on serum C-terminal propeptide of procollagen type I (DROP-PIP trial). Eur J Heart Fail 2018; 20: 460-70.
22.
Selvaraj S, Claggett B, Pozzi A, et al. Prognostic implications of congestion on physical examination among contemporary patients with heart failure and reduced ejection fraction: PARADIGM-HF. Circulation 2019; 140: 1369-79.
23.
Cosín J, Díez J; TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study [published correction appears in Eur J Heart Fail 2002 Oct;4(5):667]. Eur J Heart Fail 2002; 4: 507-13.
24.
Mentz RJ, Velazquez EJ, Metra M, et al. Comparative effectiveness of torsemide versus Furosemide in heart failure patients: insights from the PROTECT trial. Future Cardiol 2015; 11: 585-95.
25.
Abraham B, Megaly M, Sous M, et al. Meta-analysis comparing torsemide versus furosemide in patients with heart failure. Am J Cardiol 2020; 125: 92-9.
26.
Rahhal A, Saad MO, Tawengi K, Assi AAR, Habra M, Ahmed D. Torsemide versus Furosemide after acute decompensated heart failure: a retrospective observational study. BMC Cardiovasc Disord 2019; 19: 127.
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