Vasopressin antagonists in the management of heart failure.
Vasopressin antagonists have been studied in a variety of clinical settings, including patients with acute and chronic heart failure. The clinical trials published to date have sought to describe the clinical and physiologic effects of these agents in an effort to prove clinical efficacy and safety. A variety of agents with varying effects on V2 and V1a vasopressin receptor subtype have been studied. They have been shown to reduce bodyweight and improve serum sodium without worsening renal function. They may also decrease the need for loop diuretic use and may be particularly useful in patients with hyponatremia in the setting of volume overload. Further studies are underway that are powered to assess for morbidity and mortality benefits. The beneficial effects have been well documented but, until outcomes are understood more fully, the use of these agents should be limited to currently approved indications. In the USA, this includes only the treatment of euvolemic hyponatremia.
Rossi
Joseph
J
Northwestern University, Feinberg School of Medicine, 251 E. Huron Galter 10-240, Chicago IL 60611, USA. j-rossi2@md.northwestern.edu
Orlandi
Cesare
C
Gheorghiade
Mihai
M
D065092:Antidiuretic Hormone Receptor Antagonists; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D017483:Receptors, Vasopressin / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014667:Vasopressins / Q000187:drug effects / Q000378:metabolism
D065092:Antidiuretic Hormone Receptor Antagonists; D017483:Receptors, Vasopressin; D014667:Vasopressins