Oral vasopressin receptor antagonist tolvaptan in right heart failure due to pulmonary hypertension.

During the past decade, the prognosis of patients with pulmonary hypertension (PH) has improved due to the development of pulmonary arterial vasodilators [1]. Yet, treatment for right-sided heart failure (RHF) associated with PH has not improved, despite being the most important prognostic factor for chronic RHF [2, 3]. Existing treatment strategies for RHF associated with PH are restricted to administration of loop diuretics and inotropes [4]; however, administration of high doses of loop diuretics may worsen the outcome of chronic heart failure [5, 6]. In recent years, tolvaptan, an oral, nonpeptide, selective vasopressin V2-receptor antagonist, has been developed for the treatment of hyponatraemia [7], autosomal dominant polycystic kidney disease [8] and heart failure. Used in addition to standard therapy that includes diuretics, tolvaptan improves many signs and symptoms of heart failure without serious adverse events [9]. However, there is no report describing the effect of tolvaptan on RHF, independent of left-sided heart disease.