MA, Massie BM, Faxon DP, et al. . Acute and long-term effects of enalapril on the cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure . 1985; 6:163–73.
JA, Goldsmith SR, Cohn JN. . Contrasting immediate and long-term effects of isosorbide dinitrate on exercise capacity in congestive heart failure . 1980; 69:559–66.
M, Medina N, Yushak M. . Comparative hemodynamic and clinical effects of long-term treatment with prazosin and captopril for severe chronic congestive heart failure secondary to coronary artery disease or idiopathic dilated cardiomyopathy . 1986; 57:1323–7.
K, Massie B, Rubin S, Gelberg H, Brundage BH, Ports TA. . Long-term outpatient vasodilator therapy of congestive heart failure: consideration of agents at rest and during exercise . 1978; 65:134–45.
Claudio Ferroni, Aureliano Fraticelli, Enrico Paciaroni. . (1996) Intermittent dobutamine therapy in patients with advanced congestive heart failure. 23, 313-327.
In 1980, a Veterans Administration Cooperative Study was initiated to determine whether two widely employed vasodilator regimens could alter life expectancy. In a double-blind trial, men with stable chronic congestive heart failure undergoing conventional treatment with digoxin and diuretics were assigned randomly to receive additional treatment with prazosin, both hydralazine and isosorbide dinitrate, or placebo. The concept to be tested was that peripheral vasoconstriction not only contributes to hemodynamic derangement and symptoms in heart failure but also may contribute to progressive deterioration of left ventricular function and premature death.
The rationale for vasodilator therapy for heart failure is evidence that vasoconstriction in the systemic arterial and venous beds raises impedance to left ventricular ejection and shifts blood centrally from the venous capacitance vessels. The result of these circulatory effects is increased preload and afterload that adversely affect left ventricular performance and contribute to the low cardiac output and venous congestion that characterize heart failure. Studies of the hemodynamic effects of sodium nitroprusside have revealed that the relaxing effect of the drug on the arteries and veins could produce a profoundly favorable effect on left ventricular performance. Subsequent studies indicated that orally administered prazosin or hydralazine, given in combination with nitrates, could produce a similar hemodynamic effect. , , Short-term trials with these agents have produced various results. In some studies, symptoms and exercise tolerance, as well as measures of left ventricular function, have improved. In others, however, no evidence of efficacy has been observed. , None of these studies have been large enough to evaluate the influence of these drugs on mortality.
Anil Mehra, Enrique Ostrzega, Avraham Shotan, Janet V. Johnson, Uri Elkayam. . (1992) Persistent hemodynamic improvement with short-term nitrate therapy in patients with chronic congestive heart failure already treated with captopril. 70, 1310-1314.
Lilian Murray, Iain B. Squire, John L. Reid, Kennedy R. Lees. . (1998) Determinants of the blood pressure response to the first dose of ACE inhibitor in mild to moderate congestive heart failure. 45:6, 559-566.