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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 dihydropyridines (e.g., nifedipine, amlodipine) and diltiazem. Although studies in diastolic heart failure are limited at the present time, there is little to suggest a role for calcium channel blockers for this patient group.
Sildenafil
Large multicenter controlled trials are not available for sildenafil and thus this drug is not approved for use in heart failure. Initial small reports indicate that this agent may have a role in heart failure with or without concomitant pulmonary hypertension. In these early preliminary studies in heart failure, sildenafil improves exercise capacity, quality of life, and perhaps diastolic performance.
Others
Pentoxifylline, perhexiline, and trimetazidine are awaiting large multicenter trials to establish effectiveness and potentially a role in the management of heart failure.
What's the Evidence?
Cohn, JN, Ziesche, S, Smith, R. ” Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patient with chronic heart failure treated with enalapril: V-HeFT III”. Circulation. vol. 96. 1997. pp. 856-863. (This is just one of many large controlled trials showing that calcium-channel blocking agents are of limited value in the management of chronic systolic heart failure.)
Lewis, GD, Shah, R, Shahzad, K. ” Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension”. Circulation. vol. 116. 2007. pp. 1555-1562. (A preliminary placebo-controlled study showing that another vasodilator with some promise, sildenafil, may have a beneficial effect on symptoms and exercise performance.)
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