Emergency Med Medical News about acute heart failure; tolvaptan

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Tolvaptan: the evidence for its therapeutic value in acute heart failure syndrome
Core Evidence, 08/12/09

Aghel A et al. – Several clinical trials have sought to assess the clinical effects of tolvaptan in heart failure. Compared with placebo, tolvaptan has been shown to reduce bodyweight and improve serum sodium in patients with AHFS without worsening renal function. Tolvaptan appeared to be well tolerated with a good safety profile. It caused a significant reduction in pulmonary capillary wedge pressure compared with placebo, but has yet to demonstrate reversal of cardiac remodeling. A large–scale mortality trial showed no differences in long–term mortality rates between tolvaptan and placebo, although early symptom relief was apparent with tolvaptan and lower diuretic use. Tolvaptan has shown to be safe and effective in treating congestion in AHFS. Free water excretion in fluid–overloaded patients vulnerable to cardiorenal compromise with standard diuretic therapy makes V2 vasopressin receptor blockade an attractive adjunct to standard medical therapy aimed at reducing congestion in AHFS.

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