Hemodynamic effects of nitroglycerin ointment in congestive heart failure

Efficacy of ambulatory systemic vasodilator therapy with oral prazosin in chronic refractory heart failure. Concomitant relief of pulmonary congestion and elevation of pump output demonstrated by improvements in symptomatology, exercise tolerance, hemodynamics and echocardiography.

“…Therefore, while pulmonary congestion is relieved by nitrates, cardiac output is only minimally and inconsistently influenced by these agents. '4 16,19,[23][24][25] Although hydralazine recently has been shown to improve ventricular performance by raising cardiac output, it has little to no affect on left ventricular filling pressure.27 28 While the combination of hydralazine with long-acting nitrates has been demonstrated both to improve pulmonary congestion by lowering ventricular preload and to reduce fatigue by increasing cardiac output,29' 30 oral prazosin offers the advantage of a single drug which effectively accomplishes the same therapeutic purposes without the disadvantages of hydralazine side effects.3'3 Further, our clinical experience with prazosin in heart failure therapy has indicated the agent does not cause serious untoward actions; only transient headache and mild nausea were noted in two patients which did not require discontinuance of the drug. Of additional importance is that we have not observed orthostatic hypotension with the careful and individualized use of prazosin in relieving severe heart failure symptomatology, apparently because the agent did not lower left ventricular preload below the upper limits of normal ( fig.…”

“…However, attempts to continue the benefits of such balanced ventricular unloading therapy in ambulatory patients with chronic heart failure have been difficult because of the lack of an oral vasodilator drug with both arteriolar and venous relaxing properties. Thus the nitrates, which principally cause venodilation, are capable of reducing ventricular preload and pulmonary congestion3' 13,14,16,19,[23][24][25][26] but lack consistent effects on systemic impedance and therefore produce minimal alterations of cardiac output …”

Long-term vasodilator therapy for heart failure: clinical response and its relationship to hemodynamic measurements.

“…Vasodilator therapy with hydralazine and nitrates was initiated according to the protocol we have described previously.14 Maintenance doses were 200-400 mg of hydralazine daily and [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Clinical Follow-up Thirty-six patients were followed by the authors themselves or under their supervision. The referring physicians of the remaining patients were contacted to determine medication dosing, compliance and clinical status.…”

Acute and long‐term effects of captopril on exercise cardiac performance and exercise capacity in congestive heart failure.

“…Directly acting dilators of vascular smooth muscle, such as hydralazine, minoxidil, the various nitrate preparations, and a-adrenergic antagonists, such as prazosin and trimazosin, have been used alone and in combination to achieve improved cardiac performance (Franciosa et al, 1974;Chatterjee et al, 1976;Taylor et al, 1976;Franciosa et al, 1977;Massie et al, 1977;Miller et al, 1977;Franciosa & Cohn, 1978;Fitchett et al, 1979;Chatterjee et al, 1980;Franciosa et al, 1980;Awan et al, 1981a;Feldman et al, 1981;Franciosa & Cohn, 1981;Massie et al, 1981). In several recent studies captopril, an angiotensin-converting-enzyme inhibitor, produces 0306-5251/82/100143-09 $01.00 acute haemodynamic improvement in patients with chronic congestive heart failure.…”