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BMJ. 2007 March 31; 334(7595): 661.
PMCID: PMC1839208
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New treatment for heart failure given cautious welcome

Successful new treatments for decompensated heart failure have been few and far between in recent decades, so experts have given a cautious welcome to tolvaptan, a new drug that antagonises the action of arginine vasopressin on the renal collecting ducts. In trials, the drug reduced body weight in the first week of treatment and had a modest effect on breathlessness and oedema. But it did not save lives or prevent readmission to hospital in the longer term, compared with placebo (mortality at 10 months 26% in both groups). Tolvaptan did at least appear safe. There were no adverse renal effects, although 4-11% of patients reported nuisance symptoms such as thirst and dry mouth.

Most data on the new drug come from three randomised placebo controlled trials (two short term and one long term) in 4133 men and women with acutely decompensated chronic heart failure. Tolvaptan was given in addition to standard treatments including diuretics.

One commentator (pp 1374-6) suggests there's now enough evidence to support the short term use of tolvaptan when diuretics and vasodilators fail to control acute symptoms. But only in patients with the same characteristics as the trial participants—those with a history of established heart failure and reduced ejection fraction.


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