Congestive heart failure vasodilators: Difference between revisions

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/* ACC/AHA Guidelines- Combination of Hydralazine and Nitrates (DO NOT EDIT) Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antma...
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===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
'''1.''' A combination of [[hydralazine]] and a [[nitrate]] might be reasonable in patients with current or prior symptoms of [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]) who cannot be given an [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ACE inhibitor or ARB]] because of drug intolerance, [[hypotension]], or [[renal insufficiency]]. <ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2012-04-05}}</ref><ref name="pmid3520315">{{cite journal |author=Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH |title=Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study |journal=[[The New England Journal of Medicine]] |volume=314 |issue=24 |pages=1547–52 |year=1986 |month=June |pmid=3520315 |doi=10.1056/NEJM198606123142404 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198606123142404?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-05}}</ref><ref name="pmid8500244">{{cite journal |author=Loeb HS, Johnson G, Henrick A, Smith R, Wilson J, Cremo R, Cohn JN |title=Effect of enalapril, hydralazine plus isosorbide dinitrate, and prazosin on hospitalization in patients with chronic congestive heart failure. The V-HeFT VA Cooperative Studies Group |journal=[[Circulation]] |volume=87 |issue=6 Suppl |pages=VI78–87 |year=1993 |month=June |pmid=8500244 |doi= |url= |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
'''1.''' A combination of [[hydralazine]] and a [[nitrate]] might be reasonable in patients with current or prior symptoms of [[heart failure]] and reduced [[left ventricular ejection fraction]] ([[LVEF]]) who cannot be given an [[Congestive heart failure ACE inhibitors or angiotensin receptor blockers|ACE inhibitor or ARB]] because of drug intolerance, [[hypotension]], or [[renal insufficiency]]. <ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2012-04-05}}</ref><ref name="pmid3520315">{{cite journal |author=Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH |title=Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study |journal=[[The New England Journal of Medicine]] |volume=314 |issue=24 |pages=1547–52 |year=1986 |month=June |pmid=3520315 |doi=10.1056/NEJM198606123142404 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198606123142404?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-04-05}}</ref><ref name="pmid8500244">{{cite journal |author=Loeb HS, Johnson G, Henrick A, Smith R, Wilson J, Cremo R, Cohn JN |title=Effect of enalapril, hydralazine plus isosorbide dinitrate, and prazosin on hospitalization in patients with chronic congestive heart failure. The V-HeFT VA Cooperative Studies Group |journal=[[Circulation]] |volume=87 |issue=6 Suppl |pages=VI78–87 |year=1993 |month=June |pmid=8500244 |doi= |url= |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}


==Vote on and Suggest Revisions to the Current Guidelines==
==Vote on and Suggest Revisions to the Current Guidelines==

Revision as of 20:01, 5 April 2012

Congestive Heart Failure Microchapters

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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
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Coordinating Care for Patients With Chronic HF
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Congestive heart failure end-of-life considerations

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Obstructive Sleep Apnea in the Patient with CHF
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Congestive heart failure vasodilators On the Web

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Risk calculators and risk factors for Congestive heart failure vasodilators

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

  • A nitrate may be added to ACE inhibitors to relieve symptoms of pulmonary edema
  • The addition of a nitrate to an ACE inhibitor may improve exercised tolerance.
  • The combination of hydralazine and nitrates is useful in patients with advanced heart failure[1] and in particularly, when ACE inhibitors are not well tolerated.
  • Hydralazine by itself is only an arterial vasodilator and does not reduce left ventricular filling pressures to the same extent as nitrates and ACE inhibitors do. In fact when used alone it can stimulate sympathetic tone reflexively. The combination of hydralazine and nitrates has been shown to decrease mortality as well as improve the left ventricular ejection fraction and exercise capacity in patients with heart failure. However the combination of hydralazine and nitrates has been found to be less effective than ACE inhibitors.
  • The major of use of this combination is in those patients who are intolerant of ACE inhibitors.

ACC/AHA Guidelines- Combination of Hydralazine and Nitrates (DO NOT EDIT) [2][3]

“

Class I

1. The combination of hydralazine and nitrates is recommended to improve outcomes for patients self described as African-Americans, with moderate-severe symptoms on optimal therapy with ACE inhibitors, beta blockers, and diuretics.[1][4] (Level of Evidence: B)

Class IIa

1. The addition of a combination of hydralazine and a nitrate is reasonable for patients with reduced left ventricular ejection fraction (LVEF) who are already taking an ACE inhibitor and beta blocker for symptomatic heart failure and who have persistent symptoms.[4][5] (Level of Evidence: B)

Class IIb

1. A combination of hydralazine and a nitrate might be reasonable in patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency. [4][6][7] (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

Guidelines Resources

References

  1. ↑ 1.0 1.1 Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN (2004). "Combination of isosorbide dinitrate and hydralazine in blacks with heart failure". The New England Journal of Medicine. 351 (20): 2049–57. doi:10.1056/NEJMoa042934. PMID 15533851. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  3. ↑ 3.0 3.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  4. ↑ 4.0 4.1 4.2 Carson P, Ziesche S, Johnson G, Cohn JN (1999). "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group". Journal of Cardiac Failure. 5 (3): 178–87. PMID 10496190. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  5. ↑ Cohn JN (1993). "The Vasodilator-Heart Failure Trials (V-HeFT). Mechanistic data from the VA Cooperative Studies. Introduction". Circulation. 87 (6 Suppl): VI1–4. PMID 8500232. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. ↑ Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH (1986). "Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study". The New England Journal of Medicine. 314 (24): 1547–52. doi:10.1056/NEJM198606123142404. PMID 3520315. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  7. ↑ Loeb HS, Johnson G, Henrick A, Smith R, Wilson J, Cremo R, Cohn JN (1993). "Effect of enalapril, hydralazine plus isosorbide dinitrate, and prazosin on hospitalization in patients with chronic congestive heart failure. The V-HeFT VA Cooperative Studies Group". Circulation. 87 (6 Suppl): VI78–87. PMID 8500244. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)


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