Selection of vasodilator drugs for patients with severe chronic heart failure: An approach based on a new classification

M. Packer

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Although vasodilator drugs are of proven worth in the management of patients with severe heart failure, a useful system of classification of vasodilator drugs has not yet been devised. The traditional system of classification based on the dominant arterial and/or venous sites of action as determined by limb plethysmography had major conceptual and practical limitations. This article discusses the merits of a new classification format based on pharmacological mechanisms of action. According to this new system, vasodilator drugs can be divided into two groups: direct-acting agonists (hydralazine, minoxidil, nitrates and nitroprusside) which demonstrate dose-dependent responses and generalised vasodilator effects, and thus require invasive monitoring for dose titration; and neurohumoral antagonists (prazosin, trimazosin, phentolamine, captopril and teprotide), whose effects are qualitatively and quantitatively independent of the dose administered, show marked regional heterogeneity and have characteristic temporal patterns of response. This new classification system permits the rational formulation of clinical recommendations concerning the choice of a vasodilator drug for patients with severe chronic heart failure. However, widespread application of this new classification system awaits the development of reliable means of identifying patients with neurohumoral-dependent vasoconstriction without the necessity of a therapeutic trial.

Original languageEnglish (US)
Pages (from-to)64-74
Number of pages11
JournalDrugs
Volume24
Issue number1
StatePublished - 1982

Fingerprint

Vasodilator Agents
Heart Failure
Teprotide
Molecular Mechanisms of Pharmacological Action
Plethysmography
Minoxidil
Hydralazine
Prazosin
Phentolamine
Captopril
Nitroprusside
Vasoconstriction
Titration
Nitrates
Extremities
Monitoring
Therapeutics

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Toxicology

Cite this

Selection of vasodilator drugs for patients with severe chronic heart failure : An approach based on a new classification. / Packer, M.

In: Drugs, Vol. 24, No. 1, 1982, p. 64-74.

Research output: Contribution to journalArticle

@article{d29fb18481374e7ab9f293652bd7bea6,
title = "Selection of vasodilator drugs for patients with severe chronic heart failure: An approach based on a new classification",
abstract = "Although vasodilator drugs are of proven worth in the management of patients with severe heart failure, a useful system of classification of vasodilator drugs has not yet been devised. The traditional system of classification based on the dominant arterial and/or venous sites of action as determined by limb plethysmography had major conceptual and practical limitations. This article discusses the merits of a new classification format based on pharmacological mechanisms of action. According to this new system, vasodilator drugs can be divided into two groups: direct-acting agonists (hydralazine, minoxidil, nitrates and nitroprusside) which demonstrate dose-dependent responses and generalised vasodilator effects, and thus require invasive monitoring for dose titration; and neurohumoral antagonists (prazosin, trimazosin, phentolamine, captopril and teprotide), whose effects are qualitatively and quantitatively independent of the dose administered, show marked regional heterogeneity and have characteristic temporal patterns of response. This new classification system permits the rational formulation of clinical recommendations concerning the choice of a vasodilator drug for patients with severe chronic heart failure. However, widespread application of this new classification system awaits the development of reliable means of identifying patients with neurohumoral-dependent vasoconstriction without the necessity of a therapeutic trial.",
author = "M. Packer",
year = "1982",
language = "English (US)",
volume = "24",
pages = "64--74",
journal = "Drugs",
issn = "0012-6667",
publisher = "Adis International Ltd",
number = "1",

}

TY - JOUR

T1 - Selection of vasodilator drugs for patients with severe chronic heart failure

T2 - An approach based on a new classification

AU - Packer, M.

PY - 1982

Y1 - 1982

N2 - Although vasodilator drugs are of proven worth in the management of patients with severe heart failure, a useful system of classification of vasodilator drugs has not yet been devised. The traditional system of classification based on the dominant arterial and/or venous sites of action as determined by limb plethysmography had major conceptual and practical limitations. This article discusses the merits of a new classification format based on pharmacological mechanisms of action. According to this new system, vasodilator drugs can be divided into two groups: direct-acting agonists (hydralazine, minoxidil, nitrates and nitroprusside) which demonstrate dose-dependent responses and generalised vasodilator effects, and thus require invasive monitoring for dose titration; and neurohumoral antagonists (prazosin, trimazosin, phentolamine, captopril and teprotide), whose effects are qualitatively and quantitatively independent of the dose administered, show marked regional heterogeneity and have characteristic temporal patterns of response. This new classification system permits the rational formulation of clinical recommendations concerning the choice of a vasodilator drug for patients with severe chronic heart failure. However, widespread application of this new classification system awaits the development of reliable means of identifying patients with neurohumoral-dependent vasoconstriction without the necessity of a therapeutic trial.

AB - Although vasodilator drugs are of proven worth in the management of patients with severe heart failure, a useful system of classification of vasodilator drugs has not yet been devised. The traditional system of classification based on the dominant arterial and/or venous sites of action as determined by limb plethysmography had major conceptual and practical limitations. This article discusses the merits of a new classification format based on pharmacological mechanisms of action. According to this new system, vasodilator drugs can be divided into two groups: direct-acting agonists (hydralazine, minoxidil, nitrates and nitroprusside) which demonstrate dose-dependent responses and generalised vasodilator effects, and thus require invasive monitoring for dose titration; and neurohumoral antagonists (prazosin, trimazosin, phentolamine, captopril and teprotide), whose effects are qualitatively and quantitatively independent of the dose administered, show marked regional heterogeneity and have characteristic temporal patterns of response. This new classification system permits the rational formulation of clinical recommendations concerning the choice of a vasodilator drug for patients with severe chronic heart failure. However, widespread application of this new classification system awaits the development of reliable means of identifying patients with neurohumoral-dependent vasoconstriction without the necessity of a therapeutic trial.

UR - http://www.scopus.com/inward/record.url?scp=0020328693&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0020328693&partnerID=8YFLogxK

M3 - Article

C2 - 6125370

AN - SCOPUS:0020328693

VL - 24

SP - 64

EP - 74

JO - Drugs

JF - Drugs

SN - 0012-6667

IS - 1

ER -