Background: In spite of recent therapeutic advances, chronic heart failure is a frequent cause of hospitalisation and death. Inhibition of arginine vasopressin is a new, promising treatment option. We here present an overview of how vasopressin antagonists are used in chronic heart failure.
Material and methods: This article is based on a review of relevant literature found by searching Google and PubMed and studies of reference lists in identified articles.
Results and interpretation: In chronic heart failure, different neurohormonal systems are activated. Inhibition of these by beta-adrenergic blockers, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers and aldosterone inhibitors improve prognosis and reduce hospital admissions. Fluid retention and oedema are usually controlled with loop diuretics, but this treatment does probably not improve the prognosis and is potentially harmful. On the other hand, inhibition of arginine vasopressin seems to have no harmful haemodynamic consequences and may theoretically represent a step forward. As opposed to traditional diuretics, vasopressin antagonists increase excretion of free water without causing loss of electrolytes or reduced renal function. Studies in animals and the early human studies are promising. Ongoing phase III studies will hopefully clarify whether arginine vasopressin inhibition can reduce morbidity and mortality in heart failure.