The critical link of hypervolemia and hyponatremia in heart failure and the potential role of arginine vasopressin antagonists

J Card Fail. 2010 May;16(5):419-31. doi: 10.1016/j.cardfail.2009.12.021. Epub 2010 Feb 20.

Abstract

Background: Hypervolemia and hyponatremia resulting from activation of the neurohormonal system and impairment of renal function are prominent features of decompensated heart failure. Both conditions share many pathophysiologic and prognostic features and each has been associated with increased morbidity and mortality. When both conditions coexist, therapeutic options are limited.

Methods and results: This review presents a concise digest of the pathophysiology, clinical significance, and pharmacological therapy of hyponatremia complicating heart failure with a special emphasis on vasopressin antagonists and their aquaretic effects in the absence of neurohormonal activation along with their ability to correct hyponatremia.

Conclusions: Hypervolemia and hyponatremia share many pathophysiologic and prognostic features in heart failure. Vasopressin antagonists provide a viable option for their management and a potentially unique role when both conditions coexists.

Publication types

  • Review

MeSH terms

  • Antidiuretic Hormone Receptor Antagonists*
  • Arginine Vasopressin / antagonists & inhibitors
  • Arginine Vasopressin / drug effects
  • Arginine Vasopressin / therapeutic use*
  • Benzamides / therapeutic use
  • Benzazepines / therapeutic use
  • Blood Pressure
  • Blood Volume*
  • Female
  • Heart Failure / drug therapy*
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology
  • Humans
  • Hypertension / drug therapy
  • Hypertension / physiopathology
  • Hyponatremia / drug therapy
  • Hyponatremia / physiopathology*
  • Male
  • Prevalence
  • Prognosis
  • Pyrroles / therapeutic use
  • Receptors, Vasopressin / drug effects
  • Tolvaptan
  • United States / epidemiology
  • Water-Electrolyte Balance

Substances

  • Antidiuretic Hormone Receptor Antagonists
  • Benzamides
  • Benzazepines
  • Pyrroles
  • Receptors, Vasopressin
  • conivaptan
  • Arginine Vasopressin
  • Tolvaptan
  • lixivaptan