Effects of Tolvaptan With or Without the Pre-Administration of Renin-Angiotensin System Blockers in Hospitalized Patients With Acute Decompensated Heart Failure.

Abstract

We examined whether tolvaptan combined with an angiotensin II receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACE-I) is more effective than tolvaptan alone in the treatment of patients with heart failure (HF). Sixty-five hospitalized patients with acute decompensated HF were included in this study. They were divided into 2 groups; an ARB/ACE-I group (n = 44, who received ARB or ACE-I before the use of tolvaptan) and a non-ARB/ACE-I group (n = 21). There were no significant differences in patient characteristics including medications at baseline between the non-ARB/ACE-I and ARB/ACE-I groups with the exception of the percentages of hypertension and ischemic heart disease. Urinary volume (UV) at baseline in the ARB/ACE-I group was slightly higher than that in the non-ARB/ACE-I group. The increase in UV after the use of tolvaptan in the non-ARB/ACE-I group was significantly higher than that in the ARB/ACE-I group. The cardiothoracic ratio and the reduction in body weight were similar between the groups after tolvaptan use. Finally, in a logistic regression analysis, a response to the use of tolvaptan was independently associated with the non-use of ARB/ACE-I, but not with age, gender, body mass index, loop diuretic, or human arterial natriuretic peptide. In conclusion, tolvaptan alone might induce an increase in UV in decompensated HF patients without ARB/ ACE-I, although the treatment of HF with ARB/ACE-I is the first choice strategy.

• Authors: Sen Adachi, Shin-Ichiro Miura, Yuhei Shiga, Tadaaki Arimura, Joji Morii, Takashi Kuwano, Ken Kitajima, Atsushi Iwata, Natsumi Morito, Kanta Fujimi, Eiji Yahiro, Hiroaki Nishikawa, Keijiro Saku
• Journal: International heart journal (Int Heart J) Vol. 58 Issue 3 Pg. 385-392 (May 31 2017) ISSN: 1349-3299 [Electronic] Japan
• PMID: 28484118 (Publication Type: Journal Article)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Antidiuretic Hormone Receptor Antagonists
• Benzazepines
• Tolvaptan

Topics

• Acute Disease
• Aged
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Antidiuretic Hormone Receptor Antagonists (administration & dosage)
• Benzazepines (administration & dosage)
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Heart Failure (drug therapy, physiopathology)
• Humans
• Male
• Retrospective Studies
• Tolvaptan
• Treatment Outcome
• Urination (drug effects)