Short-term effects of low-dose tolvaptan on hemodynamic parameters in patients with chronic heart failure.
BACKGROUND
We evaluated the short-term effects of low-dose tolvaptan treatment on hemodynamic parameters in patients with chronic heart failure (HF).


METHODS
We studied 22 patients (69 ± 10 years) with chronic HF and excess fluid retention despite receiving appropriate medical therapy, including loop and/or thiazide diuretics. The therapeutic effects of low-dose (7.5mg) once-daily tolvaptan on hemodynamics associated with changes in fluid balance and neurohumoral activations were investigated after a seven day treatment period.


RESULTS
After the treatment period, body weight decreased (-2.7 ± 2.3 kg) associated with increases in daily urine output. Whereas plasma arginine-vasopressin levels, serum aldosterone concentration, and plasma renin activity mildly increased, plasma levels of B-type natriuretic peptide and atrial natriuretic peptide significantly decreased after tolvaptan treatment. Serum electrolytes were not adversely affected by tolvaptan treatment. Although cardiac index and systemic vascular resistance index remained unchanged, mean pulmonary artery wedge pressure (22 ± 7 mmHg vs. 17 ± 7 mmHg, p<0.05), mean right atrial pressure (12 ± 5 mmHg vs. 9 ± 5 mmHg, p<0.05), mean pulmonary artery pressure (32 ± 9 mmHg vs. 25 ± 7 mmHg, p<0.05), and pulmonary vascular resistance index (332 ± 207 dynes/cm(-5)/m(2) vs. 245 ± 110 dynes/cm(-5)/m(2), p<0.05) significantly decreased after tolvaptan treatment. The extent of the reduction in pulmonary vascular resistance index after tolvaptan treatment strongly correlated with baseline values.


CONCLUSIONS
Short-term treatment with low-dose tolvaptan improved hemodynamic parameters and correlated with significant fluid removal in patients with chronic HF.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
Kiyotaka
K
Watanabe
Kaoru
K
Dohi
Tadafumi
T
Sugimoto
Tomomi
T
Yamada
Yuichi
Y
Sato
Kazuhide
K
Ichikawa
Emiyo
E
Sugiura
Naoto
N
Kumagai
Shiro
S
Nakamori
Hiroshi
H
Nakajima
Kozo
K
Hoshino
Hirofumi
H
Machida
Shinya
S
Okamoto
Katsuya
K
Onishi
Mashio
M
Nakamura
Tsutomu
T
Nobori
Masaaki
M
Ito
D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000008:administration & dosage* / Q000494:pharmacology; D001826:Body Fluids / Q000378:metabolism; D001835:Body Weight / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000187:drug effects; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013997:Time Factors; D000077602:Tolvaptan; D014556:Urine; D014655:Vascular Resistance
D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D049993:Sodium Chloride Symporter Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors; D000077602:Tolvaptan