Vasodilator therapy for acute heart failure: haemodynamic comparison of hydralazine/isosorbide, alpha-adrenoceptor blockade, and angiotensin-converting enzyme inhibition.
Haemodynamic comparison of three vasodilation regimens [intravenous (i.v.) hydralazine and isosorbide dinitrate (ISDN) combined, i.v. doxazosin, and i.v. enalaprilat] was undertaken in 36 patients with acute left ventricular (LV) failure due to recent myocardial infarction. Each regimen achieved similar reductions in pulmonary artery occluded pressure (PAOP, preload) and systemic arterial pressures (afterload), with increased cardiac and stroke volume (SV) indexes (p less than 0.01). Only the hydralazine and isosorbide combination induced resting tachycardia. Balanced vasodilatation after selective alpha-adrenoceptor blockade (doxazosin) and angiotensin-converting enzyme (ACE) inhibition (enalaprilat) without increase in heart rate (HR) suggests that these therapies may have definite haemodynamic advantages over the hydralazine/ISDN combination.
Verma
S P
SP
University Department of Cardiovascular Studies, General Infirmary, Leeds, England.
Silke
B
B
Reynolds
G W
GW
Kelly
J G
JG
Richmond
A
A
Taylor
S H
SH
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017292:Doxazosin; D004359:Drug Therapy, Combination; D015773:Enalaprilat / Q000008:administration & dosage / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage / Q000627:therapeutic use; D007275:Injections, Intravenous; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011224:Prazosin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects
D000317:Adrenergic alpha-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents; D006830:Hydralazine; D015773:Enalaprilat; D007548:Isosorbide Dinitrate; D017292:Doxazosin; D011224:Prazosin