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Heart Failure Medication Provides Some Symptom Relief

tolvaptan group and 26.3 percent in the placebo group died. The combined outcome of cardiovascular death or hospitalization for heart failure occurred in 42 percent of the tolvaptan patients and 40.2 percent of the placebo group patients. The secondary end points of the combined outcome of cardiovascular death or cardiovascular hospitalization, the incidence of cardiovascular death and clinical worsening of HF did not differ between the 2 treatment groups. Tolvaptan significantly improved secondary end points of day 1 patient-assessed dyspnea (difficulty in breathing), day 1 body weight and day 7 edema (swelling from excessive accumulation of fluid in tissue). The frequency of major adverse events were similar in the 2 groups.

"Long-term tolvaptan treatment had no effect, either favorable or unfavorable, on all-cause mortality or the combined end point of cardiovascular mortality or subsequent hospitalization for worsening HF," the authors write. "Our long-term clinical outcome findings do not justify continuation of tolvaptan treatment beyond the time of improvement in fluid balance and clinical status. … However, our findings of sustained reduction in body weight, without worsening of renal function and with sustained normalization of serum sodium levels in patients with baseline hyponatremia [abnormally low concentration of sodium in the blood], suggest a role for either longer-term or intermittent tolvaptan treatment, at least in patients in whom abnormalities in fluid and electrolyte balance and/or renal function are difficult to manage by other means."

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