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Backgroud  Acute decompensated heart failure (ADHF) is a common and highly morbid cardiovascular disorder. Diuresis is a major therapy for the reduction of congestive symptoms. However, most diuretics cause hyponatremia, which is a worsening factor of ADHF patients prognosis. The purpose of this study was to examine the efficacy and safety of tolvaptan, which is a selective vasopressin V 2  receptor antagonist and produces water excretion without changes in sodium excretion, compared with carperitide.    Methods and Results  One hundred and nine hospitalized ADHF patients were enrolled and randomly assigned to tolvaptan or carperitide treatment groups. Subjective symptoms and plasma BNP level were similarly improved by treatment in both groups. Urine volume was significantly higher in the tolvaptan group ( P  < .05), but volume of water intake was also higher in the tolvaptan group ( P  < .05). Blood pressure was significantly lower in the carperitide group than in the tolvaptan group after treatment ( P  < .05). Less adverse events such as worsening heart failure and hypotension requiring drug discontinuation were observed in the tolvaptan group ( P  = .027). The average drug cost of tolvaptan was lower than that of carperitide ( P  < .001).    Conclusions  Tolvaptan might be a novel promising agent for ADHF in terms of efficacy and safety compared to carperitide.

Acute heart failure volume control multicenter randomized (AVCMA) trial: Comparison of tolvaptan and carperitide