Tolvaptan For The Treatment Of Heart Failure: Systematic Review And Meta-analysis

Background Heart failure (HF) is a common clinical disease. It wasdiscovered that arginine vasopressin levels were elevated in patients withheart failure and the elevation was proportional to the severity of heartfailure.Aim Selective vasopressin Receptor Antagonists(V2-receptor) inducesfree water excretion without increasing urinary sodium， improvewater-sodium retention. To assess the efficacy and safety of tolvaptan forheart failure.Methods We included all RCTs in the databases including Pubmed、Medline、Embase、Cochrane Library、CNKI. Time limit to Dec1,2013.Results were assessed by Jadad score. We analyzed data with softwareRevMan5.2.Results10randomized controlled trials (RCTs) were identified. Bodyweight significantly decreased after a single dose of tolvaptan [WMD,-0.82Kg;95%CI,(-0.90,-0.73)Kg; P<0.00001] and continued to decreasein short-term [WMD,-1.11Kg;95%CI,(-1.47,-0.75)Kg; P<0.00001].Improvement in edema and rales resolution had no significantly difference [RR,1.33;95%CI,(0.95,1.87); P=0.09] and [RR,1.43;95%CI,(0.63,3.22);P=0.39]. Changes from baseline serum sodium level was significantlyincreased [WMD,3.44MEq/L;95%CI,(2.70,4.17); P<0.00001].Incidence of worsening heart failure a significantly decreased [RR,0.68;95%CI,(0.49,0.95); P=0.02], respectively. The incidence of urinefrequency was significantly increased [RR,4.60;95%CI,(2.75,7.71);P<0.00001], the incidence of dry mouth or thirst was significantlyincreased [RR,5.65;95%CI,(4.63,6.89); P<0.00001]. The overallmortality rate had no significantly difference [RR,0.97;95%CI,(0.88,1.07); P=0.55].Conclusions Tolvaptan is efficacy and safety in patients with heartfailure in short-term.