Short-term efficacy of tolvaptan in treatment of senile chronic congestive heart failure (CHF) complicated by hyponatremia and diuretic resistance

GAO Peng; KOU Guang-ya; WU Yan-hai

doi:10.3969/j.issn.1674-4055.2017.02.07

Abstract：Objective To review the curative effect and safety of tolvaptan in treatment of senile chronic congestive heart failure (CHF) complicated by hyponatremia and diuretic resistance.Methods The patients (n=100, male 70 and female 30) were chosen from the Department of Cardiovasology of the Second People's Hospital of Xinxiang City from Mar. 2015 and May 2016. All patients were randomly divided into tolvaptan group and control group (eachn=50), and on the base of routine anti-CHF therapy, the tolvaptan group was given tolvaptan and control group was given 3%-4% hypertonic saline and high-dose furosemide for 7 d. The heart rate (HR), mean arterial pressure (MAP), body mass, serum sodium, serum potassium, left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), antidiuretic hormone (ADH), 24-h urine volume, blood urea nitrogen (BUN), serum creatinine (Scr), daily dose of furosemide, daily dose of spirolactone, clinical symptom scores and drug adverse reactions were detected, and fatality rate of cardiovascular diseases was recorded within 6 m after patients discharged from hospital in 2 groups.Results After treatment for 7 d, serum sodium, LVEF, 24-h urine volume, NT-proBNP, ADH and clinical symptom scores were ameliorated in 2 groups (allP<0.01). After treatment for 7 d, serum sodium, LVEF and 24-h urine volume were higher, and body mass, NT-proBNP, ADH, daily dose of furosemide, daily dose of spirolactone and clinical symptom scores were lower in tolvaptan group than those in control group (allP<0.05). The difference in incidence of adverse reactions had no statistical significance between 2 groups (12%vs. 18%,P>0.05). The difference in fatality rate of cardiovascular diseases had no statistical significance between 2 groups (4%vs. 2%,P>0.05) within 6 m after patients discharged from hospital.Conclusion Tolvaptan can rapidly relieve CHF symptoms and diuretic resistance and promote serum sodium with higher safety, but cannot reduce long-term fatality rate of cardiovascular diseases.