Division of Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota.
Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
J Card Fail. 2018 Feb;24(2):112-114. doi: 10.1016/j.cardfail.2017.12.011. Epub 2018 Jan 9.
Stimulation of the V1a receptor for arginine vasopressin produces myocardial and vascular effects similar to those of angiotensin II while stimulation of the V2 receptor causes fluid retention. There are no data with sustained blockade of the V1a receptor while single-dose experiments suggest benefit. Acute and chronic administration of selective V2 receptor antagonists reliably relieves dyspnea and produces diuresis without adverse effects on renal function or neurohormonal stimulation, either as adjunctive or alternative therapy to loop diuretics, but has not been shown to improve outcomes as adjunctive therapy. Combined antagonism has been tried only in single-dose studies in stable patients or over the short-term in acute heart failure, with encouraging results. Based on the both the pathophysiologic rationale for additional neurohormonal blockade and these results, chronically blocking both receptors, particularly in more congested patients, may offer significant benefit either as adjunctive or alternative therapy to standard diuretics.
血管加压素 V1a 受体的刺激会产生类似于血管紧张素 II 的心肌和血管作用，而 V2 受体的刺激会导致液体潴留。目前尚无持续阻断 V1a 受体的数据，而单次剂量实验表明有获益。选择性 V2 受体拮抗剂的急性和慢性给药可可靠地缓解呼吸困难并产生利尿作用，而不会对肾功能或神经激素刺激产生不良影响，无论是作为袢利尿剂的辅助治疗还是替代治疗，但作为辅助治疗并未显示出改善结局的作用。联合拮抗作用仅在稳定患者的单次剂量研究或急性心力衰竭的短期研究中进行过尝试，结果令人鼓舞。基于对额外神经激素阻断的病理生理基础和这些结果，长期阻断这两个受体，特别是在更充血的患者中，无论是作为标准利尿剂的辅助治疗还是替代治疗，都可能提供显著的益处。
