Acute heart failure volume control trial: the comparison of tolvaptan and carperitide

Abstract

Background: Acute decompensated heart failure (ADHF) is a common and highly morbid cardiovascular disorder. Diuresis is a major therapy for the reduction of congestive symptoms. However, most diuretics cause hyponatremia, which is a worsening factor of prognosis of ADHF patients. The purpose of this study was to examine the efficacy and safety of tolvaptan, which is a selective vasopressin V2 receptor antagonist and produces water excretion without changes in sodium excretion, compared with carperitide. Methods and results: One hundred and nine hospitalized ADHF patients were enrolled and randomly assigned tolvaptan or carperitide treatment groups. We compared the efficacy and safety of these two drugs. Subjective symptoms and plasma BNP level were similarly improved by treatment in both groups. Blood pressure was significantly lower in the carperitide group than in the tolvaptan group after treatment (P<0.05). Urine volume was significantly higher in the tolvaptan group (P<0.01), but volume of water intake was also higher in the tolvaptan group (P<0.01). Adverse cardiac events such as worsening heart failure and hypotension requiring drug discontinuation were more frequent in the carperitide group (P=0.027). The average drug cost of tolvaptan was significantly lower than that of carperitide (P<0.001). ![Figure][1] Conclusions: The present study reveals that tolvaptan is a novel promising agent for ADHF in terms of efficacy, safety, and economy compared to carperitide. [1]: pending:yes