Vasopressin receptor antagonism - a therapeutic option in heart failure and hypertension

The precise role of vasopressin in the pathophysiology of cardiovascular di sease is controversial, but this peptide hormone is important for several r easons. Firstly, circulating concentrations of vasopressin are elevated in heart failure and some forms of hypertension. Secondly, there is evidence t hat vasopressin is synthesized not only in the hypophysial-pituitary axis b ut also in peripheral tissues including the heart where it acts as a paracr ine hormone. Thirdly, vasopressin has vasoconstrictor, mitogenic, hyperplas tic and renal fluid retaining properties which, by analogy with angiotensin II, may have deleterious effects when present in chronic excess. Finally, the availability of orally active non-peptide vasopressin receptor antagoni sts allows vasopressin receptor antagonism to be considered as a therapeuti c option in cardiovascular disease.