The critical link of hypervolemia and hyponatremia in heart failure and the potential role of arginine vasopressin antagonists.
BACKGROUND
Hypervolemia and hyponatremia resulting from activation of the neurohormonal system and impairment of renal function are prominent features of decompensated heart failure. Both conditions share many pathophysiologic and prognostic features and each has been associated with increased morbidity and mortality. When both conditions coexist, therapeutic options are limited.


RESULTS
This review presents a concise digest of the pathophysiology, clinical significance, and pharmacological therapy of hyponatremia complicating heart failure with a special emphasis on vasopressin antagonists and their aquaretic effects in the absence of neurohormonal activation along with their ability to correct hyponatremia.


CONCLUSIONS
Hypervolemia and hyponatremia share many pathophysiologic and prognostic features in heart failure. Vasopressin antagonists provide a viable option for their management and a potentially unique role when both conditions coexists.
Ghali
Jalal K
JK
Detroit Medical Center, Detroit, MI. JGhali@dmc.org <JGhali@dmc.org>
Tam
S William
SW
D065092:Antidiuretic Hormone Receptor Antagonists; D001127:Arginine Vasopressin / Q000037:antagonists & inhibitors / Q000187:drug effects / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use; D001794:Blood Pressure; D001810:Blood Volume; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007010:Hyponatremia / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use; D017483:Receptors, Vasopressin / Q000187:drug effects; D000077602:Tolvaptan; D014481:United States / Q000453:epidemiology; D014882:Water-Electrolyte Balance; D001569:Benzodiazepines
D065092:Antidiuretic Hormone Receptor Antagonists; D001127:Arginine Vasopressin; D001549:Benzamides; D001552:Benzazepines; D011758:Pyrroles; D017483:Receptors, Vasopressin; D000077602:Tolvaptan; C106389:conivaptan; C409452:lixivaptan; D001569:Benzodiazepines