Use of tolvaptan vs. furosemide in older patients with heart failure : Meta-analysis of randomized controlled trials.
Herz
; 43(4): 338-345, 2018 Jun.
Article
em En
| MEDLINE
| ID: mdl-28523370
ABSTRACT
BACKGROUND:
It is not known whether older patients with acute heart failure (HF) receiving tolvaptan have decreased mortality rates and a better long-term prognosis than patients who receive furosemide. We conducted a systematic review of randomized controlled trials (RCTs) to address this issue.METHODS:
The Medline, Embase, and Cochrane Library databases were searched for English-language RCTs published before September 2016 comparing tolvaptan with furosemide treatment in older patients (>65 years old) after acute HF. The primary outcomes assessed were 6month all-cause mortality and worsening renal function (WRF); the secondary outcomes were electrolyte disorders, hospital readmissions, and adverse events.RESULTS:
Out of 669 citations, six RCTs met the inclusion criteria for this meta-analysis. There was a significant decrease in WRF (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.52-0.86, p = 0.002) and in the hospitalization period (mean difference [MD] = -1.86, 95% CI = -3.70--0.02, p = 0.05), as well as a significant increase in urine volume within 3 days of tolvaptan administration (MD = 1.59, 95% CI = 1.41-1.76, p < 0.00001). There were significant differences in creatinine levels between subgroups (MD = 0.33, 95% CI = 0.14-0.52, p = 0.0006). However, for the outcome of 6month all-cause mortality (RR = 0.56, 95% CI = 0.29-1.06, p = 0.07), there was no significant difference among all subgroups. There were significant differences in serum sodium concentration (MD = 0.68, 95% CI = 0.02-1.34, p = 0.04) but no significant changes in systolic blood pressure (MD = 3.57, 95% CI = -2.33-9.47, p = 0.24) between groups.CONCLUSION:
In older patients, tolvaptan relieves WRF, reduces the hospitalization period, and increases urine volume without significant effects on blood pressure. However, surprisingly, the use of tolvaptan did not influence 6month all-cause mortality.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Diuréticos
/
Antagonistas dos Receptores de Hormônios Antidiuréticos
/
Tolvaptan
/
Furosemida
/
Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Systematic_reviews
Limite:
Aged
/
Humans
Idioma:
En
Revista:
Herz
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
China