Abstract
We evaluated the acute and chronic effects of prazosin treatment in 11 patients with chronic congestive heart failure, NYHA functional class III and IV. Before treatment mean arterial pressure averaged 100 +/- 15 mmHg, left ventricular filling pressure 29 +/- 11 mmHg, and systemic vascular resistance 2372 +/- 1121 dynes s cm-5. Prazosin administration resulted in haemodynamic improvement in all but one patient with significant lowering of the mean arterial pressure, left ventricular filling pressure, and systemic vascular resistance. Nine patients completed a 10-week course of ambulatory treatment. Five patients remained improved while four developed significant fluid retention; two of these had transient exacerbation of congestive heart failure. This was controlled by increasing diuretic and/or prazosin treatment. After 10 weeks all nine patients had advanced to NYHA functional class II. Repeat haemodynamic measurements disclosed complete haemodynamic tolerance in one patient while three other patients showed partial tolerance with a lower cardiac output (CO) response to prazosin. The nine patients, however, still showed significant lowering of the mean arterial pressure, left ventricular filling pressure, as well as the systemic vascular resistance. Though pharmacodynamic tolerance was noted in four out of nine patients, beneficial clinical and haemodynamic effects could be demonstrated after 10 weeks of prazosin treatment in most patients. Further evaluation of the long-term effects of prazosin in chronic congestive heart failure is warranted.
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- Aronow W. S., Lurie M., Turbow M., Whittaker K., Van Camp S., Hughes D. Effect of prazosin vs placebo on chronic left ventricular heart failure. Circulation. 1979 Feb;59(2):344–350. doi: 10.1161/01.cir.59.2.344. [DOI] [PubMed] [Google Scholar]
- Awan N. A., Miller R. R., DeMaria A. N., Maxwell K. S., Neumann A., Mason D. T. Efficacy of ambulatory systemic vasodilator therapy with oral prazosin in chronic refractory heart failure. Concomitant relief of pulmonary congestion and elevation of pump output demonstrated by improvements in symptomatology, exercise tolerance, hemodynamics and echocardiography. Circulation. 1977 Sep;56(3):346–354. doi: 10.1161/01.cir.56.3.346. [DOI] [PubMed] [Google Scholar]
- Chatterjee K., Ports T. A., Arnold S., Brundage B., Parmley W. Comparison of haemodynamic effects of oral hydralazine and prazosin hydrochloride in patients with chronic congestive heart failure. Br Heart J. 1979 Dec;42(6):657–663. doi: 10.1136/hrt.42.6.657. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Elkayam U., Lejemtel T. H., Mathur M., Ribner H. S., Frishman W. H., Strom J., Sonnenblick E. H. Marked early attenuation of hemodynamic effects of oral prazosin therapy in chronic congestive heart failure. Am J Cardiol. 1979 Sep;44(3):540–545. doi: 10.1016/0002-9149(79)90409-0. [DOI] [PubMed] [Google Scholar]
- Goldman S. A., Johnson L. L., Escala E., Cannon P. J., Weiss M. B. Improved exercise ejection fraction with long-term prazosin therapy in patients with heart failure. Am J Med. 1980 Jan;68(1):36–42. doi: 10.1016/0002-9343(80)90158-8. [DOI] [PubMed] [Google Scholar]
- Israili Z. H. Correlation of pharmacological effects with plasma levels of antihypertensive drugs in man. Annu Rev Pharmacol Toxicol. 1979;19:25–52. doi: 10.1146/annurev.pa.19.040179.000325. [DOI] [PubMed] [Google Scholar]
- Mehta J., Iacona M., Pepine C. J., Conti C. R. Comparison of haemodynamic effects of oral prazosin, oral hydralazine, and intravenous nitroprusside in same patients with chronic heart failure. Br Heart J. 1979 Dec;42(6):664–670. doi: 10.1136/hrt.42.6.664. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller R. R., Awan N. A., Maxwell K. S., Mason D. T. Sustained reduction of cardiac impedance and preload in congestive heart failure with the antihypertensive vasodilator prazosin. N Engl J Med. 1977 Aug 11;297(6):303–307. doi: 10.1056/NEJM197708112970604. [DOI] [PubMed] [Google Scholar]
- Packer M., Meller J., Gorlin R., Herman M. V. Hemodynamic and clinical tachyphylaxis to prazosin-mediated afterload reduction in severe chronic congestive heart failure. Circulation. 1979 Mar;59(3):531–539. doi: 10.1161/01.cir.59.3.531. [DOI] [PubMed] [Google Scholar]
- Rubin S. A., Chatterjee K., Gelberg H. J., Ports T. A., Brundage B. H., Parmley W. W. Paradox of improved exercise but not resting hemodynamics with short-term prazosin in chronic heart failure. Am J Cardiol. 1979 Apr;43(4):810–815. doi: 10.1016/0002-9149(79)90082-1. [DOI] [PubMed] [Google Scholar]