Summary
The hemodynamic benefits of combined administration of prenalterol (P) with hydralazine (H) were evaluated in ten patients with severe chronic heart failure. Single administration of 100 mg H increased cardiac index (CI) from 2.3 to 3.0 l/min/m2, whereas pulmonary capillary wedge pressure (PWC) remained unchanged. After 3–4 weeks of treatment with 200 mg H hemodynamic improvement was maintained (CI: 2.9 l/min/m2). Additional administration of P caused further augmentation of CI (3.3 l/min/m2). After long-term treatment with the combination of H and P sustained augmentation of CI (3.2 l/min/m2), and, furthermore, a slight but significant decrease of PCW were observed (p<0.05 vs. chronic single H-therapy). Five patients were able to perform exercise testing; H improved maximal exercise capacity and exercise hemodynamics in three patients. Further improvement was observed after combined treatment (H+P) in three of five patients.
It is concluded, that prenalterol may enhance the effectiveness of hydralazine therapy in congestive heart failure by providing concomitantly the principal actions of the vasodilator and positive inotropic agent used separately. Furthermore, the results indicate that oral long-term administration of hydralazineand prenalterol can produce sustained beneficial improvement.
Zusammenfassung
Bei zehn Patienten mit schwerer, chronischer Herzinsuffizienz wurden Akut- und Langzeiteffekte von Hydralazin (H) allein, sowie in Kombination mit Prenalterol (P) untersucht. Nach akuter Verabreichung von 100 mg H stieg der mittlere Herzindex (HI) von 2,3 auf 3,0 l/min/m2 an; der mittlere Pulmonalkapillardruck (PCW) blieb unbeeinflußt. Nach 3–4wöchiger Therapie mit 200 mg H pro Tag blieb die Steigerung des HI erhalten (HI: 2,9 l/min/m2). Die zusätzliche Verabreichung von 5 mg P bewirkte eine weitere Steigerung des HI, sowohl im Akutversuch (3,3 l/min/m2) als auch nach 3–4wöchiger Kombinationstherapie (3,2 l/min/m2). Außerdem kam es nach der Langzeit-Kombinationstherapie zu einer signifikanten Senkung des PCW (p<0,05 gegenüber alleiniger Langzeittherapie mit H).
H verbesserte die maximale Arbeitstoleranz und die Belastungshämodynamik bei drei von fünf Patienten. Durch zusätzliche Verabreichung von P wurde eine weitere Verbesserung der Belastungshämodynamik bei drei Patienten erzielt.
Die Ergebnisse zeigen, daß die 3–4wöchige Therapie mit Hydralazin zu einer anhaltenden Steigerung der kardialen Pumpleistung führt. Durch zusätzliche Verabreichung von P kann eine weitere, anhaltende Verbesserung von Hämodynamik und klinischer Symptomatik erreicht werden.
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Drexler, H., Löllgen, H. & Just, H. Short- and long-term effects of hydralazine and combined hydralazine-prenalterol therapy in severe chronic congestive heart failure. Klin Wochenschr 59, 647–654 (1981). https://doi.org/10.1007/BF02593856
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DOI: https://doi.org/10.1007/BF02593856