TY - JOUR
T1 - Vasodilator and inotropic therapy for severe chronic heart failure
T2 - Passion and skepticism
AU - Packer, M.
N1 - Funding Information:
From the Division of Cardiology, Department of Medicme, Mount Sinai School of Medicine of The City University of New York, New York Dr. Packer is the recipient of a Young Investigator's Research Award R23HL-25055 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Manuscnpt received July 12, 1983; revised manuscnpt received July 25, 1983; accepted August 1, 1983.
PY - 1983
Y1 - 1983
N2 - Although substantial progress has been made in the last 5 years in the development of vasodilator and inotropic drugs for the management of patients with severe chronic heart failure, much of the enthusiasm that surrounded the introduction of many of these agents has subsequently been tempered by reports of drug failure or adverse reactions. In this review and analysis, currently available vasodilator and inotropic agents are critically and comparatively evaluated to assess their respective advantages and limitations. It is apparent that the ability of most of these drugs to produce substantial clinical benefits in patients with severe heart failure has probably been overstated. Therapy fails to achieve the desired clinical results all too frequently, possibly as the result of: the choice of an ineffective drug; the administration of an effective drug in subtherapeutic doses; the administration of an effective drug to improperly selected patients; the failure of initial hemodynamic benefits to be sustained; the occurrence of severe or serious adverse reactions; and the failure to alter concomitant therapy appropropriately. The present analysis indicates that there is no uni* formly effective or safe vasodilator or inotropic drug for patients with severe heart failure; all agents have important limitations. Of the available therapeutic choices, however, long-term converting enzyme inhibition appears to produce more consistent hemodynamic and clinical benefits with an acceptable degree of adverse reactions than other pharmacologic approaches for the management of these severely ill patients.
AB - Although substantial progress has been made in the last 5 years in the development of vasodilator and inotropic drugs for the management of patients with severe chronic heart failure, much of the enthusiasm that surrounded the introduction of many of these agents has subsequently been tempered by reports of drug failure or adverse reactions. In this review and analysis, currently available vasodilator and inotropic agents are critically and comparatively evaluated to assess their respective advantages and limitations. It is apparent that the ability of most of these drugs to produce substantial clinical benefits in patients with severe heart failure has probably been overstated. Therapy fails to achieve the desired clinical results all too frequently, possibly as the result of: the choice of an ineffective drug; the administration of an effective drug in subtherapeutic doses; the administration of an effective drug to improperly selected patients; the failure of initial hemodynamic benefits to be sustained; the occurrence of severe or serious adverse reactions; and the failure to alter concomitant therapy appropropriately. The present analysis indicates that there is no uni* formly effective or safe vasodilator or inotropic drug for patients with severe heart failure; all agents have important limitations. Of the available therapeutic choices, however, long-term converting enzyme inhibition appears to produce more consistent hemodynamic and clinical benefits with an acceptable degree of adverse reactions than other pharmacologic approaches for the management of these severely ill patients.
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U2 - 10.1016/S0735-1097(83)80230-7
DO - 10.1016/S0735-1097(83)80230-7
M3 - Editorial
C2 - 6138375
AN - SCOPUS:0021066420
SN - 0735-1097
VL - 2
SP - 841
EP - 852
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -