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Will the "Vaptans" Fulfill Their Promise?

Gary S. Francis, MD; W. H. Wilson Tang, MD

JAMA. 2004;291:2017-2018.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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 -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 endopeptidases^5-6 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.

The antidiuretic hormone arginine vasopressin (AVP) is a powerful vasoconstrictor⁷ that modulates free water transport in the kidney⁸ and has an important role in the normal regulation of cardiovascular physiology.⁹ . . . [Full Text of this Article]

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

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