Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure

M. Packer, J. Meller, N. Medina, M. Yushak, R. Gorlin

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

We performed hemodynamic studies in 11 patients with severe chronic heart failure whose symptoms had returned to their pretreatment status after 37 ± 15 weeks (mean ±S.E.M.) of therapy with the vasodilator hydralazine. The cardiac index increased from 1.85 to 3.47 liters per minute per square meter of body surface area, and systemic vascular resistance decreased from 1748 to 754 dyn/sec/cm-5 (both P < 0.01) during initial hydralazine administration but returned to pretreatment values on repeat evaluation; withdrawal of the drug produced no hemodynamic deterioration. Responsiveness to hydralazine could not be restored by doubling the oral dose or by intravenous administration; tolerance was associated with fluid retention in five patients but was not reversed by intensive diuresis. In contrast, the responses to nitroprusside evaluated before and after the development of hydralazine tolerance were unaltered; other oral vasodilators were still effective. We conclude that drug-specific tolerance may account for the lack of clinical improvement in some patients with severe heart failure who receive long-term treatment with hydralazine.

Original languageEnglish (US)
Pages (from-to)57-62
Number of pages6
JournalNew England Journal of Medicine
Volume306
Issue number2
StatePublished - 1982

Fingerprint

Hydralazine
Heart Failure
Hemodynamics
Vasodilator Agents
Drug Tolerance
Therapeutics
Body Surface Area
Diuresis
Nitroprusside
Intravenous Administration
Vascular Resistance
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure. / Packer, M.; Meller, J.; Medina, N.; Yushak, M.; Gorlin, R.

In: New England Journal of Medicine, Vol. 306, No. 2, 1982, p. 57-62.

Research output: Contribution to journalArticle

Packer, M, Meller, J, Medina, N, Yushak, M & Gorlin, R 1982, 'Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure', New England Journal of Medicine, vol. 306, no. 2, pp. 57-62.
Packer, M. ; Meller, J. ; Medina, N. ; Yushak, M. ; Gorlin, R. / Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure. In: New England Journal of Medicine. 1982 ; Vol. 306, No. 2. pp. 57-62.
@article{3a16409a6dd646c68f85085aa6599f66,
title = "Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure",
abstract = "We performed hemodynamic studies in 11 patients with severe chronic heart failure whose symptoms had returned to their pretreatment status after 37 ± 15 weeks (mean ±S.E.M.) of therapy with the vasodilator hydralazine. The cardiac index increased from 1.85 to 3.47 liters per minute per square meter of body surface area, and systemic vascular resistance decreased from 1748 to 754 dyn/sec/cm-5 (both P < 0.01) during initial hydralazine administration but returned to pretreatment values on repeat evaluation; withdrawal of the drug produced no hemodynamic deterioration. Responsiveness to hydralazine could not be restored by doubling the oral dose or by intravenous administration; tolerance was associated with fluid retention in five patients but was not reversed by intensive diuresis. In contrast, the responses to nitroprusside evaluated before and after the development of hydralazine tolerance were unaltered; other oral vasodilators were still effective. We conclude that drug-specific tolerance may account for the lack of clinical improvement in some patients with severe heart failure who receive long-term treatment with hydralazine.",
author = "M. Packer and J. Meller and N. Medina and M. Yushak and R. Gorlin",
year = "1982",
language = "English (US)",
volume = "306",
pages = "57--62",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "2",

}

TY - JOUR

T1 - Hemodynamic characterization of tolerance to long-term hydralazine therapy in severe chronic heart failure

AU - Packer, M.

AU - Meller, J.

AU - Medina, N.

AU - Yushak, M.

AU - Gorlin, R.

PY - 1982

Y1 - 1982

N2 - We performed hemodynamic studies in 11 patients with severe chronic heart failure whose symptoms had returned to their pretreatment status after 37 ± 15 weeks (mean ±S.E.M.) of therapy with the vasodilator hydralazine. The cardiac index increased from 1.85 to 3.47 liters per minute per square meter of body surface area, and systemic vascular resistance decreased from 1748 to 754 dyn/sec/cm-5 (both P < 0.01) during initial hydralazine administration but returned to pretreatment values on repeat evaluation; withdrawal of the drug produced no hemodynamic deterioration. Responsiveness to hydralazine could not be restored by doubling the oral dose or by intravenous administration; tolerance was associated with fluid retention in five patients but was not reversed by intensive diuresis. In contrast, the responses to nitroprusside evaluated before and after the development of hydralazine tolerance were unaltered; other oral vasodilators were still effective. We conclude that drug-specific tolerance may account for the lack of clinical improvement in some patients with severe heart failure who receive long-term treatment with hydralazine.

AB - We performed hemodynamic studies in 11 patients with severe chronic heart failure whose symptoms had returned to their pretreatment status after 37 ± 15 weeks (mean ±S.E.M.) of therapy with the vasodilator hydralazine. The cardiac index increased from 1.85 to 3.47 liters per minute per square meter of body surface area, and systemic vascular resistance decreased from 1748 to 754 dyn/sec/cm-5 (both P < 0.01) during initial hydralazine administration but returned to pretreatment values on repeat evaluation; withdrawal of the drug produced no hemodynamic deterioration. Responsiveness to hydralazine could not be restored by doubling the oral dose or by intravenous administration; tolerance was associated with fluid retention in five patients but was not reversed by intensive diuresis. In contrast, the responses to nitroprusside evaluated before and after the development of hydralazine tolerance were unaltered; other oral vasodilators were still effective. We conclude that drug-specific tolerance may account for the lack of clinical improvement in some patients with severe heart failure who receive long-term treatment with hydralazine.

UR - http://www.scopus.com/inward/record.url?scp=0019984730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0019984730&partnerID=8YFLogxK

M3 - Article

VL - 306

SP - 57

EP - 62

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 2

ER -