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Vasodilators in the treatment of acute heart failure: what we know, what we don't.

Publication ,  Journal Article
Metra, M; Teerlink, JR; Voors, AA; Felker, GM; Milo-Cotter, O; Weatherley, B; Dittrich, H; Cotter, G
Published in: Heart Fail Rev
December 2009

Although we have recently witnessed substantial progress in management and outcome of patients with chronic heart failure, acute heart failure (AHF) management and outcome have not changed over almost a generation. Vasodilators are one of the cornerstones of AHF management; however, to a large extent, none of those currently used has been examined by large, placebo-controlled, non-hemodynamic monitored, prospective randomized studies powered to assess the effects on outcomes, in addition to symptoms. In this article, we will discuss the role of vasodilators in AHF trying to point out which are the potentially best indications to their administration and which are the pitfalls which may be associated with their use. Unfortunately, most of this discussion is only partially evidence based due to lack of appropriate clinical trials. In general, we believe that vasodilators should be administered early to AHF patients with normal or high blood pressure (BP) at presentation. They should not be administered to patients with low BP since they may cause hypotension and hypoperfusion of vital organs, leading to renal and/or myocardial damage which may further worsen patients' outcome. It is not clear whether vasodilators have a role in either patients with borderline BP at presentation (i.e., low-normal) or beyond the first 1-2 days from presentation. Given the limitations of the currently available clinical trial data, we cannot recommend any specific agent as first line therapy, although nitrates in different formulations are still the most widely used in clinical practice.

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Published In

Heart Fail Rev

DOI

EISSN

1573-7322

Publication Date

December 2009

Volume

14

Issue

4

Start / End Page

299 / 307

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Vasoconstriction
  • Tetrazoles
  • Relaxin
  • Receptors, Endothelin
  • Pyridines
  • Prognosis
  • Peptide Fragments
  • Nitrates
  • Natriuretic Peptide, C-Type
 

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Metra, M., Teerlink, J. R., Voors, A. A., Felker, G. M., Milo-Cotter, O., Weatherley, B., … Cotter, G. (2009). Vasodilators in the treatment of acute heart failure: what we know, what we don't. Heart Fail Rev, 14(4), 299–307. https://doi.org/10.1007/s10741-008-9127-5
Metra, Marco, John R. Teerlink, Adriaan A. Voors, G Michael Felker, Olga Milo-Cotter, Beth Weatherley, Howard Dittrich, and Gad Cotter. “Vasodilators in the treatment of acute heart failure: what we know, what we don't.Heart Fail Rev 14, no. 4 (December 2009): 299–307. https://doi.org/10.1007/s10741-008-9127-5.
Metra M, Teerlink JR, Voors AA, Felker GM, Milo-Cotter O, Weatherley B, et al. Vasodilators in the treatment of acute heart failure: what we know, what we don't. Heart Fail Rev. 2009 Dec;14(4):299–307.
Metra, Marco, et al. “Vasodilators in the treatment of acute heart failure: what we know, what we don't.Heart Fail Rev, vol. 14, no. 4, Dec. 2009, pp. 299–307. Pubmed, doi:10.1007/s10741-008-9127-5.
Metra M, Teerlink JR, Voors AA, Felker GM, Milo-Cotter O, Weatherley B, Dittrich H, Cotter G. Vasodilators in the treatment of acute heart failure: what we know, what we don't. Heart Fail Rev. 2009 Dec;14(4):299–307.
Journal cover image

Published In

Heart Fail Rev

DOI

EISSN

1573-7322

Publication Date

December 2009

Volume

14

Issue

4

Start / End Page

299 / 307

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Vasoconstriction
  • Tetrazoles
  • Relaxin
  • Receptors, Endothelin
  • Pyridines
  • Prognosis
  • Peptide Fragments
  • Nitrates
  • Natriuretic Peptide, C-Type