Carl V. Leier

General (including evidence of efficacy) Hydralazine-nitrate combination These agents are generally used in combination in heart failure and most of the large trials of vasodilators in heart failure pertain to this combination. Differences between drugs within the class Refer to the discussion on hydralazine, a primary afterload-reducing agent, and nitrates, primarily preload-reducers. Administration The dose…

General (including evidence of efficacy) Other orally administered vasodilators Calcium channel blockers Available studies including several multicenter controlled trials have not determined a role for their application in dilated cardiomyopathy (ischemic and nonischemic) and heart failure. The results either show no net effect or a detrimental effect on the clinical course. This applies to the…

General (including evidence of efficacy) Oral nitrates This group includes the short-acting oral nitrates (e.g., isosorbide dinitrate), longer-acting oral nitrates (e.g., isosorbide mononitrate) and the nonoral preparations (e.g., nitroglycerin ointment or patch, sublingual nitroglycerin). Differences between drugs within the class While most nitrate preparations have been studied to some degree in heart failure, more data…

General (including evidence of efficacy) Nesiritide This is the vasodilator most recently added to the formulary for acute intervention of symptomatic heart failure, and perhaps the most controversial. Differences between drugs within the class The hemodynamic effects of nesiritide, at the recommended doses, appear to reside somewhere between those of nitroprusside and nitroglycerin. Nesiritide reduces…

General (including evidence of efficacy) Chronic vasodilator therapy With the introduction of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-adrenergic blockers, chronic vasodilator therapy has moved into a second- or third-level therapy for chronic heart failure. At the present time, chronic oral vasodilator therapy consists of hydralazine, a nitrate preparation, and a…

General (including evidence of efficacy) Nitroglycerin, intravenously administered Intravenously administered nitroglycerin has several applications in clinical medicine (e.g., unstable angina, symptomatic heart failure), but we will focus on its use in heart failure. Differences between drugs within the class IV nitroglycerin is considerably less powerful throughout its dose range than nitroprusside. Administration IV nitroglycerin is…

General (including evidence of efficacy) Vasodilators For the purpose of practical clinical application, this chapter is divided into Acute Vasodilator Intervention and Chronic Vasodilator Therapy. Differences between drugs within the class Acute vasodilator intervention Acute vasodilator therapy is directed at more urgent clinical conditions; most commonly characterized by cardiogenic dyspnea from high left ventricular end-diastolic…