Summary
The Veterans Affairs Vasodilator-Heart Failure Trials (V-HeFT I and II) provided information about heart failure treated with conventional therapy, and evaluated the long term efficacy of vasodilators. In V-HeFT I, the combination of hydralazine and isosorbide dinitrate provided a beneficial effect on prognosis in heart failure. V-HeFT II demonstrated that enalapril had a more favourable effect on 2-year survival than a combination of hydralazine plus isosorbide dinitrate. However, the hydralazine-isosorbide dinitrate combination exerted the most favourable short term impact on exercise performance and left ventricular ejection fraction.
The V-HeFT studies showed that, although not all vasodilators are alike, their differing effects might be beneficial when used in combination. Determination of the potential additive effect of the calcium antagonist felodipine, a vasodilator, when used in combination with an ACE inhibitor, is the major goal of V-HeFT III.
Similar content being viewed by others
References
Aronow WS, Greenfield RS, Alimadadian H, Danahy DT. Effect of the vasodilator trimazosin versus placebo on exercise performance in chronic left ventricular failure. American Journal of Cardiology 40: 789–793, 1977.
Awan NA, Needham KE, Evenson MK, Amsterdam EE, Mason DT. Therapeutic application of prazosin in chronic refractory congestive heart failure: tolerance and ‘tachyphylaxis’ in perspective. American Journal of Medicine 71: 153–160, 1981.
Captopril Multicenter Research Group. A placebo-controlled trial of captopril in refractory chronic congestive heart failure. Journal of the American College of Cardiology 2: 755–763, 1983.
Chatterjee K, Massie B, Rubin S, Gelberg H, Brundage BH, et al. Long-term outpatient vasodilator therapy of congestive heart failure: consideration of agents at rest and during exercise. American Journal of Medicine 65: 134–145, 1978.
Cintron G, Johnson G, Francis G, Cobb F, Cohn JN, et al. Prognostic significance of serial changes in left ventricular ejection fraction in patients with congestive heart failure. Circulation 87 (Suppl. VI): 17–23, 1993
Cohn JN. Introduction. Circulation 87 (Suppl. VI): 1–4, 1993a
Cohn JN. Physiological variables as markers for symptoms, risk, and interventions in heart failure. Circulation 87 (Suppl. VII): V11110–V11114, 1993b
Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure: results of a Veterans Administration Cooperative Study (V-HeFT). New England Journal of Medicine 314: 1547–1552, 1986.
Cohn JN, Franciosa JA. Vasodilator therapy of cardiac failure. New England Journal of Medicine 297: 27–31; 254-258, 1977.
Cohn JN, Johnson GR, Shabetai R, Loeb H, Tristani F, et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. Circulation 87 (Suppl. VI): VI–5–VI–16, 1993
Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. New England Journal of Medicine 325: 303–310, 1991.
Cohn JN, Rajfer SF. Evaluation of functional capacity in heart failure. A concensus conference. Heart Failure 6: 169–173, 1990.
Cohn JN, Rector TS. Prognosis of congestive heart failure and predictors of mortality. American Journal of Cardiology 62: 25A–30A, 1988.
Colucci WS, Wynne J, Holman RL, Braunwald E. Long-term therapy of heart failure with prazosin: A randomized double blind trial. American Journal of Cardiology 45: 337–344, 1980.
CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. New England Journal of Medicine 316: 1429–1435, 1987.
Creager MA, Massie BM, Faxon DP, Friedman SD, Kramer BL, et al. Acute and long-term effects of enalapril on the cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure. Journal of the American College of Cardiology 6: 163–170, 1985.
Drexler H, Banhardt U, Meinem T, Wollschläger H, Lehmann M, et al. Contrasting peripheral short-term and long-term effects of converting enzyme inhibition in patients with congestive heart failure: a double-blind, placebo-controlled trial. Circulation 79: 491–502, 1989.
Enalapril Congestive Heart Failure Investigators. Long-term effects of enalapril in patients with congestive heart failure: a multicenter placebo-controlled trial. Heart Failure 3: 107–110, 1985.
Frances GS, Cohn JN, Johnson G, Rector TS, Goldman S, et al. Plasma norepinephrine, plasma renin activity, and congestive heart failure: relations to survival and the effects of therapy in V-HeFT II. Circulation 87 (Suppl. VI): 40–48, 1993
Franciosa JA, Cohn JN. Effect of isosorbide dinitrate on response to submaximal and maximal exercise in patients with congestive heart failure. American Journal of Cardiology 43: 1009–1014, 1979a.
Franciosa JA, Cohn JN. Immediate effects of hydralazine-isosorbide dinitrate combination on exercise capacity and exercise hemodynamics in patients with left ventricular failure. Circulation 59: 1085–1091, 1979b.
Franciosa JA, Goldsmith SR, Cohn JN. Contrasting immediate and long term effects of isosorbide dinitrate on exercise capacity in congestive heart failure. American Journal of Medicine 69: 559–566, 1980.
Franciosa JA, Weber KT, Levine B, Kinasewitz GT, Janicki JS, et al. Hydralazine in long term treatment of chronic heart failure: Lack of difference from placebo. American Heart Journal 104: 587–594, 1982.
Guiha NH, Cohn JN, Mikulic E, Franciosa JA, Limas CJ. Treatment of refractory heart failure with infusion of nitroprusside. New England Journal of Medicine 291: 587–592, 1974.
Keogh AM, Baron DW, Hickie JB. Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation. American Journal of Cardiology 65: 903–908, 1990.
Kramer BL, Massie BM, Topic N. Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study. Circulation 67: 807–816, 1983.
Kugler J, Maskin C, Frishman W, Sonnenblick E, LeJemtel T. Regional and systemic metabolic effects of angiotensin-converting enzyme inhibition during exercise in patients with severe heart failure. Circulation 66: 1256–1261, 1982.
Leier CV, Huss P, Magorien RD, Unverferth DV. Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. Circulation 67: 817–822, 1983.
McGrath BP, Arnolda L, Matthews PG, Jackson B, Jennings G, et al. Controlled trial of enalapril in congestive cardiac failure. British Heart Journal 54: 405–414, 1985.
Pierpont GL, Cohn JN, Franciosa JA. Combined oral hydralazine-nitrate therapy in left ventricular failure: hemodynamic equivalency to sodium nitroprusside. Chest 73: 8–13, 1978.
Rubin SA, Chatterjee K, Ports TA, Gelberg HJ, Brundage BH, et al. Influence of short-term oral hydralazine therapy on exercise hemodynamics in patients with severe chronic heart failure. American Journal of Cardiology 44: 1183–1189, 1979.
Sharpe DN, Murphy J, Coxon R, Hannan SF. Enalapril in patients with chronic heart failure: a placebo-controlled, randomized, double-blind study. Circulation 70: 271–278, 1984.
Sullivan MJ, Knight D, Higginbotham MB, Cogg FR. Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure: muscle blood flow is reduced with maintenance of arterial perfusion pressure. Circulation 80: 769–781, 1989.
Szlachcic J, Massie BM, Kramer BL, Topic N, Tabau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. American Journal of Cardiology 55: 1037–1042, 1985.
Ziesche S, Cobb FR, Cohn JN, Johnson G, Tristani F, et al. Hydralazine and isosorbide dinitrate combination improves exercise tolerance in heart failure: results from V-HeFT I and V-HeFT II. Circulation 87 (Suppl. VI): VI56–VI64, 1993
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cohn, J.N. Vasodilators in Heart Failure. Drugs 47 (Suppl 4), 47–58 (1994). https://doi.org/10.2165/00003495-199400474-00008
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199400474-00008