Differences in hemodynamic effects of nitroprusside and prazosin in severe chronic congestive heart failure. Evidence for a direct negative chronotropic effect of prazosin

Milton Packer, Jose Meller, Richard Gorlin, Michael V. Herman

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To compare the hemodynamic effects of prazosin and nitroprusside in patients with severe congestive heart failure, nine patients with heart failure refractory to conventional therapy received oral prazosin and intravenous nitroprusside administered so as to produce a similar decrease in left ventricular filling pressure in each patient. By this comparison, both drugs produced similar decreases in mean right atrial pressure, mean pulmonary arterial pressure and systemic and pulmonary vascular resistance. However, with nitroprusside, cardiac index increased more (+ 0.97 versus +0.73 liters/min per m2, P < 0.01) and mean arterial pressure decreased less (-13.7 versus - 18,3 mm Hg, P < 0.05) than with prazosin. Both drugs produced similar changes in stroke volume index (+11.7 cc/beat per m2 with nitroprusside and +12.5 with prazosin) and stroke work index (+8.1 g-m/m2 with nitroprusside and +6.6 with prazosin). Therefore, the differences In the hemodynamic responses observed with the two agents were due to the significantly greater decrease in heart rate with prazosin (-8 beats/min) than with nitroprusside (-2 beats/min, P < 0.05). These clinical data support experimental evidence suggesting that there is a significant negative Chronotropic action of prazosin independent of its peripheral vascular effects.

Original languageEnglish (US)
Pages (from-to)310-317
Number of pages8
JournalThe American journal of cardiology
Issue number2
StatePublished - Aug 1979


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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