Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1978 Aug;40(8):845–850. doi: 10.1136/hrt.40.8.845

Haemodynamic effects of hydrallazine and of hydrallazine plus glyceryl trinitrate paste in heart failure.

J Mehta, C J Pepine, C R Conti
PMCID: PMC483497  PMID: 99155

Abstract

In a study designed to investigate potential non-parenteral treatment for chronic heart failure, hydrallazine, 225 to 300 mg per day, was given orally to 9 patients. There was no significant change in heart rate or mean arterial pressure as cardiac output increased. Left ventricular stroke work increased significantly and pulmonary artery wedge pressure fell. Systemic and pulmonary vascular resistances fell. With the addition of 2 per cent glyceryl trinitrate paste, there was a further decline in mean pulmonary arterial and wedge pressures, without a significant change in heart rate, arterial pressures, cardiac output, or systemic or pulmonary vascular resistance. There were no untoward effects from either form of treatment. All patients reported relief of shortness of breath and other symptoms related to ventricular dysfunction. This study supports the suggestion that oral hydrallazine is effective in increasing cardiac output and decreasing pulmonary congestion. Furthermore, the addition of topical glyceryl trinitrate provides a greater reduction of pulmonary pressures, probably through its predominant venodilator action. In some selected patients with heart failure, oral hydrallazine and topical glyceryl trinitrate in combination produce beneficial clinical and haemodynamic effects, probably through afterload and preload reduction, respectively.

Full text

PDF
845

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ABLAD B. A study of the mechanism of the hemodynamic effects of hydralazine in man. Acta Pharmacol Toxicol (Copenh) 1963;20(Suppl 1):1–53. [PubMed] [Google Scholar]
  2. Bolen J. L., Alderman E. L. Hemodynamic consequences of afterload reduction in patients with chronic aortic regurgitation. Circulation. 1976 May;53(5):879–883. doi: 10.1161/01.cir.53.5.879. [DOI] [PubMed] [Google Scholar]
  3. Chatterjee K., Parmley W. W., Ganz W., Forrester J., Walinsky P., Crexells C., Swan H. J. Hemodynamic and metabolic responses to vasodilator therapy in acute myocardial infarction. Circulation. 1973 Dec;48(6):1183–1193. doi: 10.1161/01.cir.48.6.1183. [DOI] [PubMed] [Google Scholar]
  4. Chatterjee K., Parmley W. W., Massie B., Greenberg B., Werner J., Klausner S., Norman A. Oral hydralazine therapy for chronic refractory heart failure. Circulation. 1976 Dec;54(6):879–883. doi: 10.1161/01.cir.54.6.879. [DOI] [PubMed] [Google Scholar]
  5. Chatterjee K., Parmley W. W., Swan H. J., Berman G., Forrester J., Marcus H. S. Beneficial effects of vasodilator agents in severe mitral regurgitation due to dysfunction of subvalvar apparatus. Circulation. 1973 Oct;48(4):684–690. doi: 10.1161/01.cir.48.4.684. [DOI] [PubMed] [Google Scholar]
  6. Cohn J. N. Vasodilator therapy for heart failure. The influence of impedance on left ventricular performance. Circulation. 1973 Jul;48(1):5–8. doi: 10.1161/01.cir.48.1.5. [DOI] [PubMed] [Google Scholar]
  7. Franciosa J. A., Limas C. J., Guiha N. H., Rodriguera E., Cohn J. N. Improved left ventricular function during nitroprusside infusion in acute myocardial infarction. Lancet. 1972 Mar 25;1(7752):650–654. doi: 10.1016/s0140-6736(72)90460-6. [DOI] [PubMed] [Google Scholar]
  8. Franciosa J. A., Mikulic E., Cohn J. N., Jose E., Fabie A. Hemodynamic effects of orally administered isosorbide dinitrate in patients with congestive heart failure. Circulation. 1974 Nov;50(5):1020–1024. doi: 10.1161/01.cir.50.5.1020. [DOI] [PubMed] [Google Scholar]
  9. Franciosa J. A., Pierpont G., Cohn J. N. Hemodynamic improvement after oral hydralazine in left ventricular failure: a comparison with nitroprusside infusion in 16 patients. Ann Intern Med. 1977 Apr;86(4):388–393. doi: 10.7326/0003-4819-86-4-388. [DOI] [PubMed] [Google Scholar]
  10. Ganz W., Swan H. J. Measurement of blood flow by thermodilution. Am J Cardiol. 1972 Feb;29(2):241–246. doi: 10.1016/0002-9149(72)90635-2. [DOI] [PubMed] [Google Scholar]
  11. Guiha N. H., Cohn J. N., Mikulic E., Franciosa J. A., Limas C. J. Treatment of refractory heart failure with infusion of nitroprusside. N Engl J Med. 1974 Sep 19;291(12):587–592. doi: 10.1056/NEJM197409192911201. [DOI] [PubMed] [Google Scholar]
  12. Khatri I., Uemura N., Notargiacomo A., Freis E. D. Direct and reflex cardiostimulating effects of hydralazine. Am J Cardiol. 1977 Jul;40(1):39–42. doi: 10.1016/0002-9149(77)90097-2. [DOI] [PubMed] [Google Scholar]
  13. Koch-Weser J. Myocardial inactivity of therapeutic concentrations of hydralazine and diazoxide. Experientia. 1974 Feb 15;30(2):170–171. doi: 10.1007/BF01927714. [DOI] [PubMed] [Google Scholar]
  14. MOYER J. H. Hydrallazine (apresoline) hydrochloride; pharmacological observations and clinical results in the therapy of hypertension. AMA Arch Intern Med. 1953 Apr;91(4):419–439. doi: 10.1001/archinte.1953.00240160005002. [DOI] [PubMed] [Google Scholar]
  15. Majid P. A., Sharma B., Taylor S. H. Phentolamine for vasodilator treatment of severe heart-failure. Lancet. 1971 Oct 2;2(7727):719–724. doi: 10.1016/s0140-6736(71)92098-8. [DOI] [PubMed] [Google Scholar]
  16. Mantle J. A., Russell R. O., Jr, Moraski R. E., Rackley C. E. Isosorbide dinitrate for the relief of severe heart failure after myocardial infarction. Am J Cardiol. 1976 Feb;37(2):263–268. doi: 10.1016/0002-9149(76)90322-2. [DOI] [PubMed] [Google Scholar]
  17. Mason D. T., Braunwald E. The effects of nitroglycerin and amyl nitrite on arteriolar and venous tone in the human forearm. Circulation. 1965 Nov;32(5):755–766. doi: 10.1161/01.cir.32.5.755. [DOI] [PubMed] [Google Scholar]
  18. Mehta J. Vasodilators in the treatment of heart failure. JAMA. 1977 Dec 5;238(23):2534–2536. [PubMed] [Google Scholar]
  19. Miller R. R., Vismara L. A., Williams D. O., Amsterdam E. A., Mason D. T. Pharmacological mechanisms for left ventricular unloading in clinical congestive heart failure. Differential effects of nitroprusside, phentolamine, and nitroglycerin on cardiac function and peripheral circulation. Circ Res. 1976 Jul;39(1):127–133. doi: 10.1161/01.res.39.1.127. [DOI] [PubMed] [Google Scholar]
  20. Moore-Jones D., Perry H. M., Jr Radioautographic localization of hydralazine-1-C-14 in arterial walls. Proc Soc Exp Biol Med. 1966 Jun;122(2):576–579. doi: 10.3181/00379727-122-31195. [DOI] [PubMed] [Google Scholar]
  21. Perry H. M., Jr Late toxicity to hydralazine resembling systemic lupus erythematosus or rheumatoid arthritis. Am J Med. 1973 Jan;54(1):58–72. doi: 10.1016/0002-9343(73)90084-3. [DOI] [PubMed] [Google Scholar]
  22. ROWE G. G., HUSTON J. H., MAXWELL G. M., CROSLEY A. P., Jr, CRUMPTON C. W. Hemodynamic effects of 1-hydrazinophthalazine in patients with arterial hypertension. J Clin Invest. 1955 Jan;34(1):115–120. doi: 10.1172/JCI103053. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. STUNKARD A., WERTHEIMER L., REDISCH W. Studies on hydralazine; evidence for a peripheral site of action. J Clin Invest. 1954 Jul;33(7):1047–1053. doi: 10.1172/JCI102972. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES