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Vasodilator Therapy in Chronic Congestive Heart Failure

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Summary

Vasodilator agents are relatively new additions to the armamentarium for the management of patients with congestive heart failure. Myocardial failure, irrespective of the aetiology, tends to create a vicious cycle characterised by reduced cardiac output and elevated systemic vascular resistance, which further decrease cardiac output by increasing left ventricular ejection impedance. The rationale for the use of vasodilators is to interrupt the vicious cycle by decreasing the left ventricular ejection impedance by peripheral vasodilatation. Although most vasodilator agents produce qualitatively similar haemodynamic responses, quantitatively their haemodynamic effects differ considerably. Knowledge of the haemodynamic effects of the various vasodilators helps in the selection of a particular drug for the management of such patients.

This article reviews the mechanisms of action, haemodynamic effects, pharmacokinetics, clinical usage and adverse effects of non-parenteral vasodilator agents currently available for the management of patients with chronic heart failure.

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References

  • Abrams, J.: Pharmacology of nitroglycerin and long acting nitrates and their usefulness in the treatment of chronic congestive heart failure: in Gould et al. (Eds) Vasodilator Therapy for Cardiac Disorders, pp. 129–167 (Futura Publishing Co.; Mt Kisco NY 1979).

    Google Scholar 

  • Abrams, J.: Nitroglycerin and long acting nitrates. New England Journal of Medicine 302: 1234–1237 (1980).

    PubMed  CAS  Google Scholar 

  • Ader, R.; Chatterjee, K.; Ports, T.; Brundage, B.; Hiramatsu, B. and Parmley, W.W.: Immediate and sustained hemodynamics and clinical improvement in congestive heart failure by an oral angiotensin converting enzyme inhibitor. Circulation 61: 931–937 (1980).

    PubMed  CAS  Google Scholar 

  • Ader, R.; Chatterjee, K.; Ports, T.; Hiramatsu, B. and Parmley, W.: Beneficial hemodynamic effects of angiotensin converting enzyme inhibitor in chronic refractory heart failure. American Journal of Cardiology 43: 404 (1979).

    Google Scholar 

  • Alderman, E. and Glantz, S.A.: Acute hemodynamic interventions shift the diastolic pressure-volume curve in man. Circulation 54: 662–667 (1976).

    PubMed  CAS  Google Scholar 

  • Armstrong, P.W.; Armstrong, J.A. and Marks, G.S.: Pharmacokinetic-hemodynamic studies on nitroglycerin ointments in congestive heart failure. American Journal of Cardiology 46: 670–676 (1980).

    PubMed  CAS  Google Scholar 

  • Arnold, S.B.; Williams, R.L.; Ports, T.A.; Baughman, R.A.; Benet, L.Z.; Parmely, W.W. and Chatterjee, K.: Attenuation of prazosin effect on cardiac output in chronic heart failure. Annals of Internal Medicine 91: 345–349 (1979).

    PubMed  CAS  Google Scholar 

  • Aronow, W.S.; Greenfield, P.S.; Alimadadian, H. and Danahy, D.T.: Effect of the vasodilator trimazosin versus placebo on exercise performance in chronic left ventricular failure. American Journal of Cardiology 30: 789–793 (1977).

    Google Scholar 

  • Aronow, W.S.; Lurie, M.; Turbow, W.; Whittaker, K.; Van Camp, S. and Hughes, D.: Effect of prazosin vs placebo on chronic left ventricular heart failure. Circulation 59: 344–349 (1979).

    PubMed  CAS  Google Scholar 

  • Awan, N.A.; Evenson, M.K.; Needham, K.E.; Wing, A. and Mason, D.T.: Efficacy of oral angiotensin-converting enzyme inhibition with Captopril therapy in severe chronic normotensive congestive heart failure. Am. Heart J. 101: 22–31 (1981a).

    PubMed  CAS  Google Scholar 

  • Awan, N.A.; Hermanovich, J.; Skinner, P. and Mason, D.T.: Captopril compared to prazosin in heart failure: Equal preload reduction with dissimilar pump output effects. Circulation 59 and 60: 11–180 (1979a)

    Google Scholar 

  • Awan, N.; Hemanovich, J.; Whitcomb, C; Skinner, P. and Mason, D.: Cardiocirculatory effects of afterload reduction with oral trimazosin in severe chronic heart failure. American Journal of Cardiology 44: 126–131 (1979b).

    PubMed  CAS  Google Scholar 

  • Awan, N.A.; Lee, G.; DeMaria, A.N. and Mason, D.T.: Ambulatory prazosin treatment of chronic congestive heart failure: Development of late tolerance reversible by higher dosage and interrupted substitution therapy. American Heart Journal 101: 541–547 (1981b).

    PubMed  CAS  Google Scholar 

  • Awan, N.A. and Mason, D.T.: Oral vasodilator therapy with prazosin in severe congestive heart failure. American Heart Journal 101: 695–700 (1981).

    PubMed  CAS  Google Scholar 

  • Awan, N.A.; Miller, R.R.; DeMaria, A.N.; Maxwell, K.S.; Neumann, A. and Mason, D.T.: Efficacy of ambulatory systemic vasodilator therapy with oral prazosin in chronic refractory heart failure. Circulation 56: 346–354 (1977).

    PubMed  CAS  Google Scholar 

  • Awan, N.A.; Miller, R.R. and Maxwell, K.S.: Development of systemic vasodilator tolerance to prazosin with chronic use of the agent in ambulatory therapy of severe congestive heart failure. American Journal of Cardiology 41: 367 (1978).

    Google Scholar 

  • Banka, V.S.; Bodenheimer, M.D.; Shah, R. and Helfant, R.H.: Intervention ventriculography: Comparative value of nitroglycerin, post-extrasystolic potentiation and nitroglycerin plus post-extrasystolic potentiation. Circulation 53: 632 (1976).

    PubMed  CAS  Google Scholar 

  • Baughman, R.; Arnold, S.; Benet, L.; Lin, E.; Chatterjee, K. and Williams, R.: Altered prazosin pharmacokinetics in congestive heart failure. European Journal of Clinical Pharmacology 17: 425–428 (1980).

    PubMed  CAS  Google Scholar 

  • Becker, L.C.; Fortuin, N.J. and Pitt, B.: Effects of ischemia and antianginal drugs on the distribution of radioactive microspheres in the canine left ventricle. Circulation Research 28: 263–269 (1971).

    PubMed  CAS  Google Scholar 

  • Bertel, O.; Burkart, F. and Buhler, F.: Sustained effect of chronic prazosin treatment in severe congestive heart failure. American Heart Journal 101: 529–533 (1981).

    PubMed  CAS  Google Scholar 

  • Bolen, J. and Alderman, E.: Hemodynamic consequences of afterload reduction in patients with chronic aortic regurgitation. Circulation 53: 879–883 (1976).

    PubMed  CAS  Google Scholar 

  • Brogden, R.N.; Heel, R.C.; Speight, T.M. and Avery, G.S.: Prazosin: A review of its pharmacological properties and therapeutic efficacy in hypertension. Drugs 14: 163–197 (1977).

    PubMed  CAS  Google Scholar 

  • Cairns, S.A. and Jordan, S.C.: Prazosin treatment complicated by acute febrile polyarthritis. British Medical Journal 2: 1424–1425 (1976).

    PubMed  CAS  Google Scholar 

  • Case, D.; Atlas, S.; Mouradian, J.; Fishman, R.; Sherman, R. and Laragh, J.: Proteinuria during long term Captopril therapy. Journal of the American Medical Association 244: 346–349 (1980).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K.: Vasodilators in heart failure; in Ledingham et al. (Eds) Oxford Textbook of Medicine, Chapter 12.4 (Oxford University Press, Oxford 1982).

    Google Scholar 

  • Chatterjee, K.; Brundage, B.H. and Ports, T.A.: Nonparenteral vasodilator therapy for chronic congestive heart failure. Comprehensive Therapy/Frontiers in Medicine Series, No. 8, Vol. 5: 48–55 (1979a).

    CAS  Google Scholar 

  • Chatterjee, K.; Drew, D.; Parmley, W.W.; Klausner, S.C.; Polansky, J. and Zacherte, B.: Combination vasodilator therapy for severe chronic congestive heart failure. Annals of Internal Medicine 85: 467–470 (1976a).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K.; Massie, B.; Rubin, S.; Gelberg, H.; Brundage, B.H. and Ports, T.A.: Long-term outpatient vasodilator therapy of congestive heart failure. American Journal of Medicine 65: 134–144 (1978a).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K. and Parmley, W.W.: The role of vasodilator therapy in heart failure. Progress in Cardiovascular Disease 19: 301–325 (1977).

    CAS  Google Scholar 

  • Chatterjee, K.; Parmley, W.; Swan, H.J.C.; Berman, G.; Forrester, J. and Marcus, H.: Beneficial effects of vasodilator agents in severe mitral regurgitation due to dysfunction of subvalvular apparatus. Circulation 48: 684–690 (1973).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K.; Parmley, W.W.; Massie, B.; Greenberg, B.; Werner, J.; Klausner, S. and Norman, A.: Oral hydralazine therapy for chronic refractory heart failure. Circulation 54: 879–883 (1976b).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K.; Ports, T.; Brundage, B.; Massie, B.; Holly, A. and Parmley, W.: Oral hydralazine in chronic heart failure — sustained beneficial hemodynamic effects. Annals of Internal Medicine 92: 600–604 (1980).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K.; Ports, T.A.; Arnold, S.; Brundage, B.H. and Parmley, W.W.: Comparison of haemodynamic effects of oral hydralazine and prazosin hydrochloride in patients with chronic congestive heart failure. British Heart Journal 42: 657–663 (1979b).

    PubMed  CAS  Google Scholar 

  • Chatterjee, K.; Ports, T.A. and Parmley, W.W.: Use of vasodilators in heart failure; in Donoso (Ed.) Advances and Controversies in Cardiology, Vol. 6, Chapter 8, pp. 136–193 (Thieme-Stratton, Inc.; New York 1981a).

    Google Scholar 

  • Chatterjee, K.; Ports, T.; Rubin, S.; Massie, B.; Arnold, S.; Brundagc, B. and Parmley, W.: Sustained beneficial hemodynamic effects during long-term hydralazine therapy in patients with chronic heart failure. Circulation 58: 11–28 (1978b).

    Google Scholar 

  • Chatterjee, K.; Rubin, S.A.; Ports, T. and Parmley, W.: Influence of oral prazosin therapy on exercise hemodynamics in patients with severe chronic heart failure. American Journal of Medicine 71: 140–146 (1981b).

    PubMed  CAS  Google Scholar 

  • Cohn, J.N.: Blood pressure and cardiac performance. American Journal of Medicine 55: 351–361 (1973).

    PubMed  CAS  Google Scholar 

  • Collste, P.; Haglund, K.; Lundgren, G.; Magnusson, G. and Ostman, J.: Reversible renal failure during treatment with Captopril. British Medical Journal 2: 612 (1979).

    PubMed  CAS  Google Scholar 

  • Colucci, W.S.; Williams, G. and Braunwald, E.: Increased plasma norepinephrine during prazosin treatment for severe congestive heart failure. Annals of Internal Medicine 93: 452–453 (1980a).

    PubMed  CAS  Google Scholar 

  • Colucci, W.S.; Wynne, J.; Holman, B. and Braunwald, E.: Long term therapy of heart failure with prazosin: A randomised double blind trial. American Journal of Cardiology 45: 337–344 (1980b).

    PubMed  CAS  Google Scholar 

  • Constantine, J.W.: Analysis of the hypotensive action of prazosin; in Cotton (Ed.) Prazosin — Evaluation of a New Antihypertensive Agent, pp. 16–36 (Excerpta Medica, Amsterdam 1974).

    Google Scholar 

  • Creager, M.; Halperin, J.; Bernard, D.; Faxon, D.; Melidossian, C; Gavras, H. and Ryan, T.: Acute regional circulatory and renal hemodynamic effects of converting enzyme inhibition in patients with congestive heart failure. Circulation 64: 483–489 (1981).

    PubMed  CAS  Google Scholar 

  • Curtiss, C.; Cohn, J.N.; Vrobel, T. and Franciosa, J.A.: Role of the renin-angiotensin system in the systemic vasoconstriction of chronic congestive heart failure. Circulation 58: 763–770 (1979).

    Google Scholar 

  • Davis, R.; Ribner, H.S.; Keung, E.; Sonneblick, E.H. and LeJemtel, T.H.: Effect of Captopril in heart failure. New England Journal of Medicine 301: 117–121 (1979).

    PubMed  CAS  Google Scholar 

  • DePasquale, N.P. and Burch, G.E.: Effect of angiotensin II on the intact forearm veins of man. Circulation Research 13: 239–245 (1963).

    PubMed  CAS  Google Scholar 

  • Desch, C.; Magorien, R.; Triffon, D.; Blanford, M.; Unverferth, D. and Leier, C: Development of pharmacologic tolerance to prazosin in congestive heart failure. American Journal of Cardiology 44: 1178–1182 (1979).

    PubMed  CAS  Google Scholar 

  • DuCharme, D.; Freyburger, W.; Graham, B. and Carlson, R.: Pharmacologic properties in minoxidil: A new hypotensive agent. Journal of Pharmacology and Experimental Therapeutics 184: 662–670 (1973).

    PubMed  CAS  Google Scholar 

  • Dzau, V.; Colucci, W.; Williams, G.; Curfman, G.; Meggs, L. and Hollenberg, N.: Sustained effectiveness of converting enzyme inhibitor in patients with severe congestive heart failure. New England Journal of Medicine 302: 1373–1378 (1980).

    PubMed  CAS  Google Scholar 

  • Dzau, V.; Colucci, W.; Hollenberg, N. and Williams, G.: Relationship of renin-angiotensin-aldosterone system to clinical state in congestive heart failure. Circulation 63: 645–657 (1981).

    PubMed  CAS  Google Scholar 

  • Engel, S.; Schaeffer, T.R.; Gold, B. and Rubin, B.: Inhibition of pressor effects of angiotensin I and augmentation of depressor effects of bradykinin by synthetic peptides. Proceedings of the Society for Experimental Biological Medicine 140: 240–244 (1972).

    CAS  Google Scholar 

  • Elkayam, U.; LeJemtel, T.; Mathur, M.; Ribner, H.; Frishman, W.; Strom, J. and Sonneblick, E.H.: Marked early attenuation of hemodynamic effects of oral prazosin therapy in chronic congestive heart failure. American Journal of Cardiology 43: 403 (1979).

    Google Scholar 

  • Emerson, T.: Effects of angiotensin, epinephrine, norepinephrine and vasopressin on venous return. American Journal of Physiology 210: 933–942 (1966).

    PubMed  CAS  Google Scholar 

  • Faxon, D.; Halperin, J.; Creager, M.; Gavras, H.; Schick, E. and Ryan, T.: Angiotensin converting enzyme inhibitor in severe congestive heart failure — acute and limb hemodynamics of Captopril and observations on sustained oral treatment. American Heart Journal 101: 548–555 (1981).

    PubMed  CAS  Google Scholar 

  • Feldman, R.C.; Ball, R.M.; Winchester, M.A.; Jaillon, P.; Kates, R.E. and Harrison, D.C.: Beneficial haemodynamic response to chronic prazosin therapy in congestive heart failure. American Heart Journal 101: 534–540 (1981a).

    PubMed  CAS  Google Scholar 

  • Feldman, R.; Pepine, C. and Conti, R.: Magnitude of dilatation of large and small coronary arteries by nitroglycerin. Circulation 64: 324–332 (1981b).

    PubMed  CAS  Google Scholar 

  • Fitchett, D.; Neto, J.; Oakley, C. and Goodwin, J.: Hydralazine in the management of left ventricular failure. American Journal of Cardiology 44: 303–309 (1979).

    PubMed  CAS  Google Scholar 

  • Forrester, J.S.; Ganz, W.; Diamond, G.; McHugh, T.; Chonette, D.W. and Swan, H.J.C.: Thermodilution cardiac output determination with a single flow-directed catheter. American Heart Journal 83: 306–311 (1972).

    PubMed  CAS  Google Scholar 

  • Foud, F.M.; Ceimo, J.M.; Tarazi, R.C and Bravo, E.L.: Converting enzyme inhibition (CEI) in normotensive heart failure (HF): Long term hemodynamic and humoral effects. Circulation 59 and 60: 11–130 (1979).

    Google Scholar 

  • Franciosa, J. and Cohn, J.: Hemodynamic improvement with hydralazine in left heart failure. Clinical Research 24: 217 (1976).

    Google Scholar 

  • Franciosa, J.A. and Cohn, J.N.: Hemodynamic effects of trimazosin in patients with left ventricular failure. Clinical Pharmacologic Therapy 23: 11 (1978a).

    CAS  Google Scholar 

  • Franciosa, J.A. and Cohn, J.N.: Sustained hemodynamic effects of nitrates without tolerance in heart failure. Circulation 58: 11–28 (1978b).

    Google Scholar 

  • Franciosa, J.A. and Cohn, J.N.: Immediate effects of hydralazineisosorbide dinitrate combination on exercise capacity and exercise hemodynamics in patients with left ventricular failure. Circulation 59: 1085–1091 (1979).

    PubMed  CAS  Google Scholar 

  • Franciosa, J. and Cohn, J.: Effects of minoxidil on hemodynamics of patients with congestive heart failure. Circulation 63: 652–657 (1981).

    PubMed  CAS  Google Scholar 

  • Franciosa, J.; Park, M. and Levine, T.: Lack of correlation between exercise capacity and indicators of rest left ventricular performance in heart failure. American Journal of Cardiology 47: 33–39 (1981).

    PubMed  CAS  Google Scholar 

  • Franciosa, J.A.; Pierpoit, G. and Cohn, J.: Hemodynamic improvement after oral hydralazine in left ventricular failure. Annals of Internal Medicine 86: 388 (1977).

    PubMed  CAS  Google Scholar 

  • Fries, E.D.; Rose, J.C.; Higgins, T.F.; Finnerty, F.A.; Kelley, R.T. and Partenope, E.A.: The hemodynamic effects of hypotensive drugs in man. IV. 1-hydrazinopthalazine. Circulation 8: 199–204 (1953).

    Google Scholar 

  • Gavras, H.; Faxon, D.P.; Berkoberr, J.; Brunner, H.R. and Ryan, T.J.: Angiotensin converting enzyme inhibition in patients with congestive heart failure. Circulation 58: 770–776 (1979).

    Google Scholar 

  • Gelberg, H.J.; Rubin, S.A.; Ports, T.A.; Brundage, B.H.; Parmley, W.W. and Chatterjee, K.: Detection of left ventricular functional reserve by supine exercise hemodynamics in patients with severe chronic heart failure. American Journal of Cardiology 44: 1062–1067 (1979).

    PubMed  CAS  Google Scholar 

  • Goldman, S.A.; Johnson, L.L.; Escala, E.; Cannon, P.J. and Weiss, M.B.: Improved exercise ejection fraction with long-term prazosin therapy in patients with heart failure. American Journal of Medicine 68: 36–42 (1980).

    PubMed  CAS  Google Scholar 

  • Goldsmith, S.R.; Franciosa, J.A. and Cohn, J.N.: Contrasting acute and chronic effects of nitrates on exercise capacity in heart failure. American Journal of Cardiology 43: 404 (1979).

    Google Scholar 

  • Graham, R. and Pettinger, W.: Prazosin. New England Journal of Medicine 300: 232–236 (1979).

    PubMed  CAS  Google Scholar 

  • Graham, R.M.; Muir, M.R. and Mayes, J.M.: Differing effects of the vasodilator drugs, prazosin and diazoxide on plasma renin activity in the dog. Clinical Experimental Pharmacology and Physiology 3: 173–177 (1976).

    CAS  Google Scholar 

  • Greenberg, B. and Massie, B.: Beneficial effects of afterload reduction therapy in patients with congestive heart failure and moderate aortic stenosis. Circulation 61: 1212–1216 (1981).

    Google Scholar 

  • Gross, F. and Bock, K.: Some contributions to the pharmacology of synthetic angiotensin. Circulation 25: 193–199 (1962).

    PubMed  CAS  Google Scholar 

  • Grossman, A.; Eckland, D.; Price, P. and Edwards, C.: Captopril, reversible renal failure with severe hyperkalemia. Lancet 1: 712 (1980).

    PubMed  CAS  Google Scholar 

  • Halperin, J.L.; Creager, M.A.; Faxon, D.P.; Gavras, H. and Ryan, T.J.: Chronic oral angiotensin inhibition for the treatment of refractory heart failure. Circulation 59 and 60: 11–39 (1979).

    Google Scholar 

  • Harshaw, C.; Grossman, W.; Munro, A. and McLaurin, L.: Reduced systemic vascular resistance as therapy for severe mitral regurgitation of valvular origin. Annals of Internal Medicine 83: 312–316 (1975).

    PubMed  CAS  Google Scholar 

  • Heel, R.C.; Brogden, R.N.; Speight, T.M. and Avery, G.S.: Captopril: A preliminary review of its pharmacological properties and therapeutic efficacy. Drugs 20: 409–452 (1980).

    PubMed  CAS  Google Scholar 

  • Helfant, R.H.; Pine, R.; Meister, S.G.; Feldman, M.S.; Trout, R.G. and Banka, V.S.: Nitroglycerin to unmask reversible asynergy: Correlation with post coronary bypass ventriculography. Circulation 50: 108–113 (1974).

    PubMed  CAS  Google Scholar 

  • Horowitz, L.D.; Gorlin, R.; Taylor, W.J. and Kemp, H.G.: Effects of nitroglycerin on regional myocardial blood flow in coronary artery disease. Journal of Clinical Investigation 50: 1578–1584 (1971).

    Google Scholar 

  • Jaillon, P.: Clinical pharmacokinetics of prazosin. Clinical Pharmacokinetics 5: 365–376 (1980).

    PubMed  CAS  Google Scholar 

  • Kirkendall, W.M. and Page, E.B.: Polyneuritis occurring during hydralazine therapy. Journal of the American Medical Association 167: 427–432 (1958).

    PubMed  CAS  Google Scholar 

  • Klausner, S.C.; Ratshin, R.A.; Tyberg, J.V.; Lappin, H.A.; Chatterjee, K. and Parmley, W.W.: The similarity of changes in segmental contraction patterns induced by post-extrasystolic potentiation and nitroglycerin. Circulation 54: 615–623 (1976).

    PubMed  CAS  Google Scholar 

  • Klein, R.C.; Amsterdam, E.A.; Pratt, C.; Laslett, L.; Miller, M.; Lee, G.; DeMaria, A.N. and Mason, D.T.: Sustained reduction of elevated left ventricular filling pressure in cardiac failure by oral long-acting nitrate therapy. Clinical Research 26: 243A (1978).

    Google Scholar 

  • Koch-Weser, J.: Vasodilator drugs in the treatment of hypertension. Archives of Internal Medicine 133: 1017–1027 (1974).

    PubMed  CAS  Google Scholar 

  • Koch-Weser, J.: Hydralazine. New England Journal of Medicine 295: 320–323 (1976).

    PubMed  CAS  Google Scholar 

  • Kovick, R.B.; Tillesch, J.M.; Berens, S.C.; Bramowitz, A.D. and Shine, K.I.: Vasodilator therapy for chronic left ventricular failure. Circulation 53: 322–328 (1976).

    PubMed  CAS  Google Scholar 

  • Langer, S.Z.: Presynaptic receptors and their role in the regulation of transmitter release. British Journal of Pharmacology 60: 481–497 (1977).

    PubMed  CAS  Google Scholar 

  • Leier, C.V.; Desch, C.E.; Magorien, R.D.; Triffon, D.W.; Unverferth, D.V.; Boudoulas, M. and Lewis, R.P.: Positive inotropic effects of hydralazine in human subjects: Comparison with prazosin in the setting of congestive heart failure. American Journal of Cardiology 46: 1039–1044 (1980).

    PubMed  CAS  Google Scholar 

  • Leier, C.V.; Magorien, R.D.; Desch, C.E.; Thompson, M.J. and Unverferth, D.V.: Hydralazine and isosorbide dinitrate: Comparative central and regional hemodynamic effects when administered alone or in combination. Circulation 63: 102–109 (1981).

    PubMed  CAS  Google Scholar 

  • Lee, G.; Mason, D.T. and DeMaria, A.N.: Effects of long term oral administration of isosorbide dinitrate on the antianginal response to nitroglycerin. Absence of nitrate cross-tolerance and self-tolerance shown by exercise testing. American Journal of Cardiology 41: 82–87 (1978).

    PubMed  CAS  Google Scholar 

  • LeJemtel, T.; Hellman, C.; Elkayan, U.; Strom, J.; Blaufox, M.D.; Frishman, W.; Ribner, H. and Sonneblick, E.: Hemodynamic and renal responses to oral hydralazine therapy in severe heart failure. Circulation 56 and 57 (Suppl. III): III–9 (1977).

    Google Scholar 

  • Levine, T.B.; Carlyle, P.F.; Gross, K.A.; Franciosa, J.A. and Cohn, J.N.: Hemodynamic and clinical response to Captopril in congestive heart failure. Circulation 59 and 60: 11–39 (1979).

    Google Scholar 

  • Lowenthal, D.T. and Affrime, M.B.: Pharmacology and pharmacokinetics of minoxidil. Journal of Cardiovascular Pharmacology 2(Suppl 2): 93–106 (1980).

    Google Scholar 

  • Maroko, P.R. and Braunwald, E.: Modification of myocardial infarction size after coronary occlusion. Annals of Internal Medicine 79: 720–733 (1973).

    PubMed  CAS  Google Scholar 

  • Mason, D.E.; Awan, N.A. and Hermanovich, J.: Comparison of cardiocirculatory actions of the oral systemic vasodilators trimazosin and prazosin, demonstration of similar useful efficacy in therapy of severe heart failure. American Journal of Cardiology 43: 403 (1979).

    Google Scholar 

  • Mason, D.T. and Braunwald, E.: The effects of nitroglycerin and amyl nitrate on arteriolar and venous tone in the human forearm. Circulation 32: 755–756 (1965).

    PubMed  CAS  Google Scholar 

  • Mason, D.T.; Hermanovich, J.; Evensen, M. and Awan, N.A.: Oral Captopril in ambulatory management of severe congestive heart failure. Am. J. Cardiol. 45: 411 (1980).

    Google Scholar 

  • Mason, D.T.; Zelis, R. and Amsterdam, E.A.: Action of the nitrates on the peripheral circulation and myocardial oxygen consumption: Significance in the relief of angina pectoris. Chest 59: 296–305 (1971).

    PubMed  CAS  Google Scholar 

  • Massie, B.; Chatterjee, K.; Werner, J.; Greenberg, B.; Hart, R. and Parmley, W.W.: Hemodynamic advantage of combined administration of hydralazine orally and nitrates nonparenterally in the vasodilator therapy of chronic heart failure. American Journal of Cardiology 40: 794–801 (1977).

    PubMed  CAS  Google Scholar 

  • Massie, B.; Kramer, B. and Haughom, F.: Postural hypotension and tachycardia during hydralazine isosorbide dinitrate treatment for congestive heart failure. Circulation 63: 658–664 (1981a).

    PubMed  CAS  Google Scholar 

  • Massie, B.M.; Kramer, B.; Shen, E. and Haughom, F.: Differing hemodynamic effects of hydralazine and nitrates during exercise compared to rest in chronic heart failure. Clinical Research 28: 10A (1979).

    Google Scholar 

  • Massie, B.; Ports, T.; Chatterjee, K.; Parmley, W.; Ostlund, J.; O’Young, J. and Haughom, F.: Long term vasodilator treatment for congestive heart failure: Clinical response and its related hemodynamic measurements. Circulation 63: 269–278 (1981b).

    PubMed  CAS  Google Scholar 

  • Matsumoto, S.; Ito, T.; Sada, T.; Takahashi, M.; Su, K.; Ueda, A.; Okabe, F.; Sata, M.; Sekine, I. and Ito, Y.: Hemodynamic effects of nifedipine in congestive heart failure. American Journal of Cardiology 46: 476–479 (1980).

    PubMed  CAS  Google Scholar 

  • McAnulty, J.H.; Hattenhauer, M.T.; Rosch, J.; Kloster, F.E. and Rahimtoda, S.H.: Improvement in left ventricular wall motion following nitroglycerin. Circulation 51: 140–145 (1975).

    PubMed  CAS  Google Scholar 

  • McKay, C.; Chatterjee, K.; Raff, G.; Brundage, B. and Parmley, W.: Comparative hemodynamic and clinical response to Isordil, diazoxide and hydralazine in severe precapillary pulmonary hypertension. Am. J. Cardiol. 47: 422 (1981).

    Google Scholar 

  • McKay, C.; Norman, A.; Chatterjee, K.; Ader, R.; Ports, T.; Brundage, B. and Parmley, W.: Comparative hemodynamics of sublingual isosorbide dinitrate and intravenous isoproterenol in precapillary pulmonary hypertension. Clinical Research 28: 10A (1979).

    Google Scholar 

  • Mehta, J.; Iacona, M.; Pepine, C. and Conti, C.R.: Comparative hemodynamic effects of nitroprusside, prazosin and hydralazine in refractory heart failure. American Journal of Cardiology 41: 418 (1978a).

    Google Scholar 

  • Mehta, J.; Pepine, C. and Conti, C.R.: Hemodynamic effects of hydralazine and hydralazine plus glyceryl trinitrate paste in heart failure. British Heart Journal 40: 845–850 (1978b).

    PubMed  CAS  Google Scholar 

  • Mehta, T.; Iacona, M.; Feldman, R.L.; Pepine, C.J. and Conti, C.R.: Comparative hemodynamic effects of intravenous nitroprusside and oral prazosin in refractory heart failure. American Journal of Cardiology 41: 925–930 (1978c).

    PubMed  CAS  Google Scholar 

  • Miller, R.R.; Awan, N.A.; Maxwell, K.S. and Mason, D.T.: Sustained reduction of cardiac impedance and preload in congestive heart failure with the antihypertensive vasodilator, prazosin. New England Journal of Medicine 297: 303–307 (1977).

    PubMed  CAS  Google Scholar 

  • Morrow, J.D.; Schroeder, H.A. and Perry, H.M. Jr. Studies in the control of hypertension by hyphex II. Toxic reaction and side effects. Circulation 8: 829–839 (1953).

    PubMed  CAS  Google Scholar 

  • Nickelson, M.: Vasodilators; in Goodman and Gillman (Eds) The Pharmacological Basis of Therapeutics, Fifth Edition, p. 733 (MacMillan and Co.; New York 1975).

    Google Scholar 

  • Nishith, S.; Davis, L. and Youmans, W.: Cardioaccelereator action of angiotensin. Am. J. Physiol. 202: 237–240 (1962).

    PubMed  CAS  Google Scholar 

  • Opie, L.H.: Nitrates. Lancet 1: 750–753 (1980).

    PubMed  CAS  Google Scholar 

  • Packer, M.; Meller, J.; Gorlin, R.; Teichholz, L. and Herman, M.: Hydralazine induced ischemia without tachycardia: The importance of coronary perfusion pressure gradients. American Journal of Cardiology 41: 398 (1978).

    Google Scholar 

  • Packer, M.; Meller, J.; Gorlin, R. and Herman, M.V.: Hemodynamic and clinical tachyphylaxis to prazosin-mediated afterload reduction in severe chronic congestive heart failure. Circulation 59: 531–539 (1979a).

    PubMed  CAS  Google Scholar 

  • Packer, M.; Meller, J.; Medina, N.; Gorlin, G. and Herman, M.: Equivalent hemodynamic effects of intravenous nitroprusside and high oral doses of oral isosorbide dinitrate in severe heart failure. Circulation 59 and 60: 11–182 (1979b).

    Google Scholar 

  • Packer, M.; Meller, J.; Medina, N.; Gorlin, R. and Herman, M.V.: Dose requirements in patients with severe chronic congestive heart failure: Evaluation of dose needed to obtain significant hemodynamic response. American Journal of Cardiology 45: 655–660 (1980).

    PubMed  CAS  Google Scholar 

  • Packer, M.; Meller, J.; Medina, N. and Yushak, M.: Sustained effect of minoxidil in heart failure after development of tolerance in other vasodilators. American Journal of Cardiology 48: 375–379 (1981a).

    PubMed  CAS  Google Scholar 

  • Packer, M.; Meller, J.; Medina, N.; Yushak, M. and Gorlin, R.: Determinants of drug response in severe chronic heart failure. I. Activation of vasoconstrictor forces during vasodilator therapy. Circulation 64: 506–514 (1981b).

    PubMed  CAS  Google Scholar 

  • Parfrey, P.S.; Clement, M.; Vandenburg, M. and Wright, P.: Captopril induced pemphigus. Brit. Med. J. 2: 194 (1980).

    Google Scholar 

  • Parmley, W.W. and Chatterjee, K.: Vasodilator therapy; in current Problems in Cardiology, Vol. No. 12, pp. 8–75 (Year Book Medical Publications, Chicago 1978).

    Google Scholar 

  • Parmley, W.W.; Chuck, L.; Chatterjee, K.; Swan, H.J.C.; Klausner, S.C.; Glantz, S.A. and Ratshen, R.A.: Acute changes in the diastolic pressure volume relationship of the left ventricle. European Journal of Cardiology 4 (Suppl): 105–120 (1976).

    PubMed  Google Scholar 

  • Perry, H.: Late toxicity to hydralazine resembling systemic lupus erythematosus or rheumatoid arthritis. American Journal of Medicine 54: 56–72 (1973).

    Google Scholar 

  • Perry, H.M. Jr., Tan, F.M.; Carmody, S. and Sakanata, A.: Relationship of acetyltransferase activity to antinuclear antibodies and toxic symptoms in hypertensive patients treated with hydralazine. Journal of Laboratory and Clinical Medicine 76: 114–117 (1970).

    PubMed  Google Scholar 

  • Pettinger, W.: Minoxidil and the treatment of severe hypertension. New England Journal of Medicine 303: 922–926 (1980).

    PubMed  CAS  Google Scholar 

  • Pierpont, G.L.; Brown, D.C.; Franciosa, J.A. and Cohn, J.N.: Effect of hydralazine on renal function in patients with congestive heart failure. Circulation 61: 323–327 (1980).

    PubMed  CAS  Google Scholar 

  • Ports, T.A.; Chatterjee, K.; Wilkinson, P.; Hiramatsu, B. and Parmley, W.W.: Beneficial hemodynamic effects of a new oral vasodilator, trimazosin, in chronic heart failure. Clinical Research 28: 13A (1980).

    Google Scholar 

  • Prins, E.; Hoorntje, S.; Weening, J. and Donkon, A.: Nephrotic syndrome in a patient on Captopril. Lancet 2: 306–307 (1979).

    PubMed  CAS  Google Scholar 

  • Rananathan, K.B.; Bodenheimer, M.M.; Banka, V.S. and Helfant, R.H.: Severity of contraction abnormalities after myocardial infarction in man: Response to nitroglycerin. Circulation 60: 1230–1237 (1979).

    Google Scholar 

  • Raskin, N.H. and Fishman, R.A.: Pyridoxine-deficiency neuropathy due to hydralazine. New England Journal of Medicine 273: 1182–1185 (1965).

    PubMed  CAS  Google Scholar 

  • Riggs, K.; Mason, D.T. and Lee, G.: Direct inotropic effect of afterload reducing agents, hydralazine and prazosin, evaluated on isolated cat papillary muscle preparations. American Journal of Cardiology 41: 388 (1978).

    Google Scholar 

  • Romankiewicz, J.A.; Brogden, R.N.; Heel, R.C.; Speight, T.M. and Avery, G.S.: Captopril: An update review of its pharmacological properties and therapeutic efficacy in congestive heart failure. Drugs 25: 6–40 (1983).

    PubMed  CAS  Google Scholar 

  • Rose, J.; Kot, P.; Cohn, J.N.; Freis, E.D. and Eckert, G.E.: Comparison of the effects of angiotensin and norepinephrine on pulmonary circulation, systemic arteries, and veins, on the systemic vascular capacity in the dog. Circulation 25: 247–252 (1962).

    PubMed  CAS  Google Scholar 

  • Rouleau, J-L.; Warnica, J. and Burgess, J.: Prazosin and congestive heart failure: Short and long term therapy. American Journal of Medicine 71: 147–152 (1981).

    PubMed  CAS  Google Scholar 

  • Rubin, R. and Blaschke, T.: Clinical pharmacology of prazosin. I. Cardiovascular, catecholamine and endocrine changes following a single dose. British Journal of Clinical Pharmacology 10: 23–32 (1980).

    PubMed  CAS  Google Scholar 

  • Rubin, L. and Peter, R.: Oral hydralazine therapy for primary pulmonary hypertension. New England Journal of Medicine 302: 69–73 (1980).

    PubMed  CAS  Google Scholar 

  • Rubin, S.A.; Chatterjee, K.; Gelberg, H.J.; Ports, T.A.; Brundage, B.H. and Parmley, W.W.: Paradox of improved exercise but not resting hemodynamics with short term prazosin in chronic heart failure. Am. J. Cardiol. 43: 810–815 (1979a).

    PubMed  CAS  Google Scholar 

  • Rubin, S.A.; Chatterjee, K.; Ports, T.A.; Gelberg, H.J.; Brundage, B.H. and Parmley, W.W.: Influence of short-term oral hydralazine therapy on exercise hemodymamics in patients with severe chronic heart failure. American Journal of Cardiology 44: 1183–1189 (1979b).

    PubMed  CAS  Google Scholar 

  • Ruskin, J.N. and Hutter, A.M. Jr: Primary pulmonary hypertension treatment with oral phentolamine. Annals of Internal Medicine 90: 772–774 (1979).

    PubMed  CAS  Google Scholar 

  • Sarnoff, S.J. and Farr, H.W.: Spinal anesthesia in the therapy of pulmonary edema: A preliminary report. Anesthesiology 5: 1–69 (1944).

    Google Scholar 

  • Seedat, Y.: Apthous ulcers of the mouth from Captopril. Lancet 2: 1297–1298 (1979).

    PubMed  CAS  Google Scholar 

  • Scroop, G.C.; Walsh, J.A. and Whelan, R.F.: A comparison of the effects of intraarterial and intravenous infusions of angiotensin and noradrenaline on the circulation in man. Clinical Science 29: 315–326 (1965).

    PubMed  CAS  Google Scholar 

  • Sharpe, N. and Long, B.: Efficacy of oral, slow release phentolamine in severe congestive heart failure. Circulation 58: II–247 (1978).

    Google Scholar 

  • Sniderman, A.; Marpole, D.; Palmer, W. and Fallon, E.; Response of the LV to nitroglycerin in patients with and without mitral regurgitation. British Heart Journal 36: 357–359 (1978).

    Google Scholar 

  • Sonnenblick, E.H.; Ross, J. Jr. and Braunwald, E.: Oxygen-consumption of the heart. New concepts of its multifactorial determination. Am. J. Cardiol. 22: 328–336 (1968).

    PubMed  CAS  Google Scholar 

  • Stanaszek, W.F.; Kellerman, D.; Brogden, R.N. and Romankiewicz, J.A.: Prazosin update. A review of its pharmacological properties and therapeutic use in hypertension and congestive heart failure. Drugs 25: 339–384 (1983).

    PubMed  CAS  Google Scholar 

  • Swan, H.J.C.; Ganz, W.; Forrester, J.S.; et al.; Catheterization of the heart in man with the use of a flow directed balloon-tip catheter. New Eng. J. Med. 283: 447–451 (1970).

    PubMed  CAS  Google Scholar 

  • Swartz, S.; Williams, G.; Hollenberg, N.; Levine, L.; Dluhy, R. and Moore, T.; Captopril induced changes in prostaglandins production: Relationship to vascular responses in normal man. Journal of Clinical Investigation 65: 1257–1263 (1980).

    PubMed  CAS  Google Scholar 

  • Talseth, T.: Studies on hydralazine. I. Serum concentrations of hydralazine in man after a single dose and at steady state. European Journal of Clinical Pharmacology 10: 183–187 (1976).

    CAS  Google Scholar 

  • Talseth, T.: Clinical pharmacokinetics of hydralazine. Clinical Pharmacokinetics 2: 317–329 (1977).

    PubMed  CAS  Google Scholar 

  • Taylor, W.R.; Forrester, J.; Magnusson, P.; Takano, T.; Chatterjee, K. and Swan, H.J.C.; The hemodynamic effects of nitroglycerin ointment in congestive heart failure. American Journal of Cardiology 38: 469–473 (1976).

    PubMed  CAS  Google Scholar 

  • Turini, G.A.; Brunner, H.R.; Gribic, M.; Waeber, B. and Gavras, H.: Improvement of chronic congestive heart failure by oral Captopril. Lancet 1: 1213–1215 (1979).

    PubMed  CAS  Google Scholar 

  • Van Brummelen, P.; Willemze, R.; Tan, W. and Thompson, J.; Captopril associated agranulocytosis. Lancet 1: 150 (1980).

    PubMed  Google Scholar 

  • Vlasses, P. and Ferguson, R.; Temporary ageusia related to Captopril. Lancet 2: 526 (1979).

    PubMed  CAS  Google Scholar 

  • Walsh, N. and Greenberg, G.: Results of long term vasodilator therapy in patients with refractory congestive heart failure. Circulation 64: 499–505 (1981).

    PubMed  CAS  Google Scholar 

  • Winbury, M.M.: Redistribution of left ventricular blood flow produced by nitroglycerin. Circulation Research 1(Suppl. I): 140–147 (1971).

    Google Scholar 

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  1. Cardiovascular Division, Department of Medicine, School of Medicine, University of California, Room 1186 Moffitt, San Francisco, California, 94143, USA

    Alan B. Schwartz &  Kanu Chatterjee

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Schwartz, A.B., Chatterjee, K. Vasodilator Therapy in Chronic Congestive Heart Failure. Drugs 26, 148–173 (1983). https://doi.org/10.2165/00003495-198326020-00003

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