Effect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure. Results of a Veterans Administration Cooperative Study

Cohn, Jay N.; Archibald, D.; Ziesche, Susan; Franciosa, Joseph A.; Harston, William E.; Tristani, Felix E.; Dunkman, W. Bruce; Jacobs, William; Francis, Gary S.; Flohr, Kathleen H.; Goldman, Steve; Cobb, Frederick R.; Shah, Pratik; Saunders, Rob; Fletcher, Ross D.; Loeb, Henry S.; Hughes, Vincent C.; Baker, Brian

doi:10.1097/00132586-198702000-00050

Cited by 456 publications

(595 citation statements)

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“…In ACHF, oral nitrates can be used to relieve concomitant angina but only have a long-term benefit on survival and hospitalisation when used in conjunction with hydralazine [53]. In the African-American Heart Failure Trial, a fixed dose combination of isosorbide dinitrate and hydralazine reduced all-cause mortality and HF hospitalisations and improved quality of life, compared to placebo, in 1050 black patients with NYHA class III or IV HF on optimal medical treatment including diuretics and neurohormonal antagonists [54].…”

Section: Nitratesmentioning

confidence: 99%

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

357

242

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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

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Section: Nitratesmentioning

confidence: 99%

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

357

242

View full text Add to dashboard Cite

show abstract

“…In the past alpha blockers were considered as possible drugs for the treatment of heart failure and were not thought to be likely to cause it or to make it worse. 11 Whilst the difference between prazosin and placebo was not statistically significant, close examination of data on 642 men from the Vasodilator-Heart Failure Trial-1 (VeHFT-I) revealed 91 deaths (49.7%) in the prazosin group, compared to 120 deaths (44.0%) in those on placebo and 72 deaths (38.7%) in the hydralazine-nitrate group. 11 By reducing peripheral vascular resistance, the alpha-receptor blockers should reduce left ventricular after-load and therefore have effects which are beneficial and somewhat similar to those seen with ACE inhibitors or hydralazine with nitrates.…”

mentioning

confidence: 99%

Do alpha blockers cause heart failure and stroke? Observations from ALLHAT

Beevers

Lip

2000

J Hum Hypertens

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“…Large-scale clinical trials with other ␤-adrenoceptor blockers are under way. Results of attempts to improve clinical status or survival in patients with heart failure by blocking ␣ 1 -adrenoceptors using prazosin have been disappointing (63); the benefit of inhibiting catecholamine synthesis using ␣-methyl-p-tyrosine (64) or of inhibiting sympathetic outflow using clonidine (65, 66) remains uncertain.…”

Section: Congestive Heart Failurementioning

confidence: 99%

Dysautonomias: Clinical Disorders of the Autonomic Nervous System

Goldstein

Robertson²,

Esler³

et al. 2002

Ann Intern Med

182

111

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The term dysautonomia refers to a change in autonomic nervous system function that adversely affects health. The changes range from transient, occasional episodes of neurally mediated hypotension to progressive neurodegenerative diseases; from disorders in which altered autonomic function plays a primary pathophysiologic role to disorders in which it worsens an independent pathologic state; and from mechanistically straightforward to mysterious and controversial entities. In chronic autonomic failure (pure autonomic failure, multiple system atrophy, or autonomic failure in Parkinson disease), orthostatic hypotension reflects sympathetic neurocirculatory failure from sympathetic denervation or deranged reflexive regulation of sympathetic outflows. Chronic orthostatic intolerance associated with postural tachycardia can arise from cardiac sympathetic activation after "patchy" autonomic impairment or blood volume depletion or, as highlighted in this discussion, from a primary abnormality that augments delivery of the sympathetic neurotransmitter norepinephrine to its receptors in the heart. Increased sympathetic nerve traffic to the heart and kidneys seems to occur as essential hypertension develops. Acute panic can evoke coronary spasm that is associated with sympathoneural and adrenomedullary excitation. In congestive heart failure, compensatory cardiac sympathetic activation may chronically worsen myocardial function, which rationalizes treatment with ␤-adrenoceptor blockers. A high frequency of positive results on tilt-table testing has confirmed an association between the chronic fatigue syndrome and orthostatic intolerance; however, treatment with the salt-retaining steroid fludrocortisone, which is usually beneficial in primary chronic autonomic failure, does not seem to be beneficial in the chronic fatigue syndrome. Dysautonomias are an important subject in clinical neurocardiology. The notion that the sympathetic nervous system coordinates body functions probably originated with the second-century Greek physician Galen, who taught that nerves were hollow tubes distributing "animal spirits" in the body, thereby fostering concerted action, or "sympathy," of the organs. In 1552, Bartolomeo Eustachius first depicted the sympathetic nerves and the adrenal glands. Winslow reintroduced the sympathetic nervous system in 1732 to describe the chains of ganglia and nerves connected to the thoracic and lumbar spinal cord.The functions of these structures remained unknown until the 19th century, when Bernard and others first reported the effects of sympathetic nerve stimulation. In 1895, Oliver and Schäfer described the potent cardiovascular stimulatory effects of adrenal extracts. Soon afterward-almost exactly a century ago-Abel and Takamine identified epinephrine ("adrenaline" in British and European countries) as the active principle of the adrenal gland.Also in the late 19th century, Langley coined the term autonomic nervous system to denote the portion of the nervous system largely responsible for involuntary, unc...

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Effect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure. Results of a Veterans Administration Cooperative Study

Cited by 456 publications

References 0 publications

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Do alpha blockers cause heart failure and stroke? Observations from ALLHAT

Dysautonomias: Clinical Disorders of the Autonomic Nervous System

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