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Vasodilators in Heart Failure

Conclusions from V-HeFT II and Rationale for V-HeFT III

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Summary

The Veterans Affairs Vasodilator-Heart Failure Trials (V-HeFT I and II) provided information about heart failure treated with conventional therapy, and evaluated the long term efficacy of vasodilators. In V-HeFT I, the combination of hydralazine and isosorbide dinitrate provided a beneficial effect on prognosis in heart failure. V-HeFT II demonstrated that enalapril had a more favourable effect on 2-year survival than a combination of hydralazine plus isosorbide dinitrate. However, the hydralazine-isosorbide dinitrate combination exerted the most favourable short term impact on exercise performance and left ventricular ejection fraction.

The V-HeFT studies showed that, although not all vasodilators are alike, their differing effects might be beneficial when used in combination. Determination of the potential additive effect of the calcium antagonist felodipine, a vasodilator, when used in combination with an ACE inhibitor, is the major goal of V-HeFT III.

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References

  • Aronow WS, Greenfield RS, Alimadadian H, Danahy DT. Effect of the vasodilator trimazosin versus placebo on exercise performance in chronic left ventricular failure. American Journal of Cardiology 40: 789–793, 1977.

    Article  PubMed  CAS  Google Scholar 

  • Awan NA, Needham KE, Evenson MK, Amsterdam EE, Mason DT. Therapeutic application of prazosin in chronic refractory congestive heart failure: tolerance and ‘tachyphylaxis’ in perspective. American Journal of Medicine 71: 153–160, 1981.

    Article  PubMed  CAS  Google Scholar 

  • Captopril Multicenter Research Group. A placebo-controlled trial of captopril in refractory chronic congestive heart failure. Journal of the American College of Cardiology 2: 755–763, 1983.

    Article  Google Scholar 

  • Chatterjee K, Massie B, Rubin S, Gelberg H, Brundage BH, et al. Long-term outpatient vasodilator therapy of congestive heart failure: consideration of agents at rest and during exercise. American Journal of Medicine 65: 134–145, 1978.

    Article  PubMed  CAS  Google Scholar 

  • Cintron G, Johnson G, Francis G, Cobb F, Cohn JN, et al. Prognostic significance of serial changes in left ventricular ejection fraction in patients with congestive heart failure. Circulation 87 (Suppl. VI): 17–23, 1993

    Google Scholar 

  • Cohn JN. Introduction. Circulation 87 (Suppl. VI): 1–4, 1993a

    Google Scholar 

  • Cohn JN. Physiological variables as markers for symptoms, risk, and interventions in heart failure. Circulation 87 (Suppl. VII): V11110–V11114, 1993b

    Google Scholar 

  • Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure: results of a Veterans Administration Cooperative Study (V-HeFT). New England Journal of Medicine 314: 1547–1552, 1986.

    Article  PubMed  CAS  Google Scholar 

  • Cohn JN, Franciosa JA. Vasodilator therapy of cardiac failure. New England Journal of Medicine 297: 27–31; 254-258, 1977.

    Article  PubMed  CAS  Google Scholar 

  • Cohn JN, Johnson GR, Shabetai R, Loeb H, Tristani F, et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. Circulation 87 (Suppl. VI): VI–5–VI–16, 1993

    Google Scholar 

  • Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. New England Journal of Medicine 325: 303–310, 1991.

    Article  PubMed  CAS  Google Scholar 

  • Cohn JN, Rajfer SF. Evaluation of functional capacity in heart failure. A concensus conference. Heart Failure 6: 169–173, 1990.

    Google Scholar 

  • Cohn JN, Rector TS. Prognosis of congestive heart failure and predictors of mortality. American Journal of Cardiology 62: 25A–30A, 1988.

    Article  PubMed  CAS  Google Scholar 

  • Colucci WS, Wynne J, Holman RL, Braunwald E. Long-term therapy of heart failure with prazosin: A randomized double blind trial. American Journal of Cardiology 45: 337–344, 1980.

    Article  PubMed  CAS  Google Scholar 

  • CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. New England Journal of Medicine 316: 1429–1435, 1987.

    Article  Google Scholar 

  • Creager MA, Massie BM, Faxon DP, Friedman SD, Kramer BL, et al. Acute and long-term effects of enalapril on the cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure. Journal of the American College of Cardiology 6: 163–170, 1985.

    Article  PubMed  CAS  Google Scholar 

  • Drexler H, Banhardt U, Meinem T, Wollschläger H, Lehmann M, et al. Contrasting peripheral short-term and long-term effects of converting enzyme inhibition in patients with congestive heart failure: a double-blind, placebo-controlled trial. Circulation 79: 491–502, 1989.

    Article  PubMed  CAS  Google Scholar 

  • Enalapril Congestive Heart Failure Investigators. Long-term effects of enalapril in patients with congestive heart failure: a multicenter placebo-controlled trial. Heart Failure 3: 107–110, 1985.

    Google Scholar 

  • Frances GS, Cohn JN, Johnson G, Rector TS, Goldman S, et al. Plasma norepinephrine, plasma renin activity, and congestive heart failure: relations to survival and the effects of therapy in V-HeFT II. Circulation 87 (Suppl. VI): 40–48, 1993

    Google Scholar 

  • Franciosa JA, Cohn JN. Effect of isosorbide dinitrate on response to submaximal and maximal exercise in patients with congestive heart failure. American Journal of Cardiology 43: 1009–1014, 1979a.

    Article  PubMed  CAS  Google Scholar 

  • Franciosa JA, Cohn JN. Immediate effects of hydralazine-isosorbide dinitrate combination on exercise capacity and exercise hemodynamics in patients with left ventricular failure. Circulation 59: 1085–1091, 1979b.

    Article  PubMed  CAS  Google Scholar 

  • Franciosa JA, Goldsmith SR, Cohn JN. Contrasting immediate and long term effects of isosorbide dinitrate on exercise capacity in congestive heart failure. American Journal of Medicine 69: 559–566, 1980.

    Article  PubMed  CAS  Google Scholar 

  • Franciosa JA, Weber KT, Levine B, Kinasewitz GT, Janicki JS, et al. Hydralazine in long term treatment of chronic heart failure: Lack of difference from placebo. American Heart Journal 104: 587–594, 1982.

    Article  PubMed  CAS  Google Scholar 

  • Guiha NH, Cohn JN, Mikulic E, Franciosa JA, Limas CJ. Treatment of refractory heart failure with infusion of nitroprusside. New England Journal of Medicine 291: 587–592, 1974.

    Article  PubMed  CAS  Google Scholar 

  • Keogh AM, Baron DW, Hickie JB. Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation. American Journal of Cardiology 65: 903–908, 1990.

    Article  PubMed  CAS  Google Scholar 

  • Kramer BL, Massie BM, Topic N. Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study. Circulation 67: 807–816, 1983.

    Article  PubMed  CAS  Google Scholar 

  • Kugler J, Maskin C, Frishman W, Sonnenblick E, LeJemtel T. Regional and systemic metabolic effects of angiotensin-converting enzyme inhibition during exercise in patients with severe heart failure. Circulation 66: 1256–1261, 1982.

    Article  PubMed  CAS  Google Scholar 

  • Leier CV, Huss P, Magorien RD, Unverferth DV. Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. Circulation 67: 817–822, 1983.

    Article  PubMed  CAS  Google Scholar 

  • McGrath BP, Arnolda L, Matthews PG, Jackson B, Jennings G, et al. Controlled trial of enalapril in congestive cardiac failure. British Heart Journal 54: 405–414, 1985.

    Article  PubMed  CAS  Google Scholar 

  • Pierpont GL, Cohn JN, Franciosa JA. Combined oral hydralazine-nitrate therapy in left ventricular failure: hemodynamic equivalency to sodium nitroprusside. Chest 73: 8–13, 1978.

    Article  PubMed  CAS  Google Scholar 

  • Rubin SA, Chatterjee K, Ports TA, Gelberg HJ, Brundage BH, et al. Influence of short-term oral hydralazine therapy on exercise hemodynamics in patients with severe chronic heart failure. American Journal of Cardiology 44: 1183–1189, 1979.

    Article  PubMed  CAS  Google Scholar 

  • Sharpe DN, Murphy J, Coxon R, Hannan SF. Enalapril in patients with chronic heart failure: a placebo-controlled, randomized, double-blind study. Circulation 70: 271–278, 1984.

    Article  PubMed  CAS  Google Scholar 

  • Sullivan MJ, Knight D, Higginbotham MB, Cogg FR. Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure: muscle blood flow is reduced with maintenance of arterial perfusion pressure. Circulation 80: 769–781, 1989.

    Article  PubMed  CAS  Google Scholar 

  • Szlachcic J, Massie BM, Kramer BL, Topic N, Tabau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. American Journal of Cardiology 55: 1037–1042, 1985.

    Article  PubMed  CAS  Google Scholar 

  • Ziesche S, Cobb FR, Cohn JN, Johnson G, Tristani F, et al. Hydralazine and isosorbide dinitrate combination improves exercise tolerance in heart failure: results from V-HeFT I and V-HeFT II. Circulation 87 (Suppl. VI): VI56–VI64, 1993

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Box 488, 420 Delaware Street, S.E., Minneapolis, Minnesota, 55455-0392, USA

    Jay N. Cohn

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Cohn, J.N. Vasodilators in Heart Failure. Drugs 47 (Suppl 4), 47–58 (1994). https://doi.org/10.2165/00003495-199400474-00008

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