title: Vasodilation by urapidil in the treatment of chronic congestive heart failure in addition to angiotensin-converting enzyme inhibitors is not beneficial: results of a placebo-controlled, double-blind study.
abstract: BACKGROUND
  The therapeutic benefit of an angiotensin-converting enzyme (ACE) inhibitor in combination with a different type of vasodilator is unknown.
  
  
  RESULTS
  To evaluate the effects of a combined therapy on quality of life, exercise tolerance, and hemodynamic parameters, patients with severe heart failure (New York Heart Association classes III and IV, ejection fraction below 35%) who were on ACE inhibitor therapy were randomly assigned to additional double-blind treatment with urapidil (60-120 mg/d) or placebo for 12 weeks. After enrollment of 36 patients, the study was terminated early because no beneficial effects on exercise tolerance and hemodynamic parameters could be shown for the urapidil treatment, and a trend toward increased mortality of the urapidil group was observed (odds ratio, 4.92 [0.49-49.6]; P = .167).
  
  
  CONCLUSIONS
  The combination of urapidil with an ACE inhibitor in the treatment of severe chronic congestive heart failure does not seem to offer any advantages over therapy with an ACE inhibitor alone and may have potentially harmful effects.
authors.affiliation: Department of Cardiology, University Hospital Göttingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Dorszewski
authors.forename: E
authors.initials: E
authors.lastname: Göhmann
authors.forename: B
authors.initials: B
authors.lastname: Dorsźewski
authors.forename: G S
authors.initials: GS
authors.lastname: Werner
authors.forename: H
authors.initials: H
authors.lastname: Kreuzer
authors.forename: H R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D002908:Chronic Disease; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use*; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010101:Oxygen Consumption; D010879:Piperazines / Q000627:therapeutic use*; D011788:Quality of Life; D016019:Survival Analysis; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D010879:Piperazines; D014665:Vasodilator Agents; D004656:Enalapril; D002216:Captopril; C015568:urapidil