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April 28, 2004

Vasopressin Receptor AntagonistsWill the "Vaptans" Fulfill Their Promise?

Author Affiliations

Author Affiliations: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.

JAMA. 2004;291(16):2017-2018. doi:10.1001/jama.291.16.2017

Heart failure with decompensated systemic congestion is a common reason for cardiovascular hospitalization among patients older than 65 years.1 Even though renin-angiotensin-aldosterone blockers and β-adrenergic blockers are highly effective therapies and remain the cornerstones of chronic treatment for heart failure, many patients with acute congestive decompensation have hyponatremia and hypervolemia that is poorly responsive to conventional loop diuretics. In recent clinical trials, use of drugs designed to block cytokines,2,3 endothelin receptors,4 and neutral endopeptidases5,6 was often limited to patients with compensated heart failure, and the results were disappointing. New data are now emerging, however, and have rekindled interest in blocking neurohormonal systems, leading to restored circulatory homeostasis and improved organ function.

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