title: Response and tolerance to oral vasodilator up-titration after intravenous vasodilator therapy in advanced decompensated heart failure.
abstract: OBJECTIVE
  The aim of this study was to assess the haemodynamic response and tolerance to aggressive oral hydralazine/isosorbide dinitrate (HYD/ISDN) up-titration after intravenous vasodilator therapy in advanced decompensated heart failure (ADHF).
  
  
  RESULTS
  Medical records of 147 consecutive ADHF patients who underwent placement of a pulmonary artery catheter and received intravenous vasodilator therapy were reviewed. Intravenous sodium nitroprusside and sodium nitroglycerin as first-line agent for those with preserved blood pressures were utilized in 143 and 32 patients, respectively. Sixty-one percent of patients were converted to oral HYD/ISDN combination therapy through a standardized conversion protocol. These patients had a significantly higher admission mean pulmonary arterial wedge pressure compared with patients not converted (28 ± 7 vs. 25 ± 8 mmHg, respectively; P-value 0.024). Beneficial haemodynamic response to decongestive therapy, defined as low cardiac filling pressures and cardiac index ≥2.20 L/min/m(2) without emergent hypotension, was achieved in 32% and 29% of patients who did or did not receive oral HYD/ISDN, respectively (P-value 0.762). HYD/ISDN dosing was progressively and consistently decreased up to the moment of hospital discharge and during outpatient follow-up, primarily due to incident hypotension.
  
  
  CONCLUSIONS
  The use of a standardized haemodynamically guided up-titration protocol for conversion from intravenous to oral vasodilators may warrant subsequent dose reductions upon stabilization.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.|Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.|Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: Frederik H
authors.initials: FH
authors.lastname: Verbrugge
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Matthias
authors.initials: M
authors.lastname: Dupont
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Finucan
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: Alaa
authors.initials: A
authors.lastname: Gabi
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: Nael
authors.initials: N
authors.lastname: Hawwa
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.|Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents
keywords: Haemodynamics; Hydralazine; Isosorbide dinitrate; Systolic heart failure; Vasodilator agents