Author Affiliations: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
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.
Francis GS, Tang WHW. Vasopressin Receptor AntagonistsWill the "Vaptans" Fulfill Their Promise?. JAMA. 2004;291(16):2017-2018. doi:10.1001/jama.291.16.2017