Is vasopressin-receptor antagonism an advancement in the treatment of heart failure?

Abstract

Despite diuretics being used to relieve the fluid retention/congestion associated with heart failure (HF), patients with HF are commonly hospitalised due to progressive volume retention with an increase in body weight and the deterioration of symptoms. Arginine vasopressin acts at vasopressin V2 receptors in the kidney as an antidiuretic. Tolvaptan is an orally-active selective V2-receptor antagonist. In the Acute and Chronic Therapeutic Impact of a Vasopressin antagonist in Congestive Heart Failure trial of patients hospitalised with HF, tolvaptan 30 mg/day increased urine volume and induced a weight loss of 3.3 kg at discharge (placebo; 1.9 kg). In post hoc analyses, mortality was lower with tolvaptan in patients with renal impairment and severe congestion, compared to placebo. Thus, it seems that tolvaptan is an advancement in the treatment of severely decompensated HF.