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Effects of vasodilators on resting and exercise hemodynamics in patients with chronic congestive heart failure Susumu Higaki 1 , Hisao Tomiya 1 , Kuninobu Makita 1 , Toshio Fukuda 1 , Yasushi Nakamura 1 1Department of Medicine, Yohkaichiba City Hospital pp.647-658
Published Date 1981/6/15
DOI https://doi.org/10.11477/mf.1404203792
  • Abstract
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The effects of oral vasodilators on both resting and exercise hemodynamics were studied in 24 patients with chronic congestive heart failure. Vasodilators included prazosin (PZ), isosorbide dinitrate (ID) and hydralazine (HD).

Significant hemodynamic responses to 0.5 to 1.5 mg of prazosin were obtained within one hour, reaching its peak effect during 2 to 4 hours and terminating 6 hours after PZ. Cardiac index (CI) increased markedly from 2.45+0.53 to 3.46±1.18L/min/m2 (p<0.05), together with signifi-cant (p<0.05) increase in stroke index and left ventricular stroke worke index (LVSWI), while systemic vascular resistance (SVR,2302±974 to 1497±614 dynes・sec/cm5), left ventricular filling pressure (LVFP, 24.6+1.4 to 12.8+3.8 mmHg) and mean pulmonary artery pressure (PAm, 34.0 ±4.3 to 19.5±7.0 mmHg) decreased significantly (p<0.01). Mean systemic blood pressure lowered slightly but significantly but heart rate remained unchanged. Such significant first dose effects had been obtained throughout the first 7 days with 2 to 6 mg of constant daily dose of PZ, with remarkable improvement of effort tolerance and exercise hemodynamics determined by a multistage ergometric stress testing in the supine position. Thus, after 7 days short-term PZ therapy, benifical hemodynamic responses were record-ed in patients with refractory congestive heart failure in this series, despite other studies reporting tachphylaxis to higher (5 to 10 mg) serial doses of this drug. The effects of ID were observed within 30 min and continued for 4 hours. Five mg of ID lowered LVFP (22.8+±.0 to 14.9 ±3.9 mmHg, p<0.01) and PAm (33.5±6.1 to 22.4±8.3 mmHg, p<0.001) and improved LVSWI significantly, although increase in CI was not statistically significant. Hydralazine increased in CI and decreased in SVR markedly without any significant changes in LVFP and PAm. Remark-able long-term (3 to 6 months) effects on functional capacity of those vasodilators were observed in 13 out of 18 patients initially showing III or IV of functional capacity.


Copyright © 1981, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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