Minoxidil in patients with chronic left heart failure: contrasting hemodynamic and clinical effects in a controlled trial.

Abstract

Minoxidil, a potent predominant arterial dilator, improves hemodynamics over the short term in patients with heart failure. In random double-blind fashion 17 patients with chronic left heart failure were given minoxidil (nine patients) or placebo (eight patients) in addition to digoxin and diuretics for 3 months. Cardiac index and heart rate increased and mean arterial pressure and systemic vascular resistance fell within 4 hr of minoxidil administration. Right heart and pulmonary arterial pressures were unchanged over the short term but rose after long-term minoxidil. After 3 months of minoxidil treatment, systemic vascular resistance was still reduced ( failure who had been symptomatic for at least 3 months despite treatment with digitalis and diuretics were selected for study. The diagnosis of congestive heart failure was based on a histo-y of symptoms on exertion and the presence of a ventricular gallop sound, jugular venous distention, pulmonary rales, or otherwise unexplained peripheral edema. In addition, all patients were required to have at least one of the following during the month preceding enrollment into the study: (1) cardiothoracic ratio on standard chest x-ray of greater than 0.55, (2) left ventricular ejection fraction less than 40% by radionuclide angiography, (3) echocardiographic left ventricular end-diastolic dimension greater than 2.7 cm/m2, or (4) resting cardiac index by carbon dioxide rebreathing below 2.5 liters/min/m2.The cause of congestive heart failure was coronary artery 63

Drugs That May Cause or Exacerbate Heart Failure

“…However, there were more clinical events (eg, worsening HF, an increased need for diuretics, and death) in the minoxidil group (21 events) than the placebo group (7 events; P<0.01). 84 …”

Minoxidil Associated Pericardial Effusion: A Case Report

“…Although the cause of the pericardial effusion in the patient discussed here is uncertain, malignancy, uremia, MI and autoimmune disease were ruled out. It is important to note that despite undergoing a pericardial window, the effusion did not resolve until minoxidil was discontinued, underlying the importance of acknowledging the link between minoxidil and pericardial effusion [7][8][9][10][11].…”

Dose requirements and hemodynamic effects of transdermal nitroglycerin compared with placebo in patients with congestive heart failure.

“…2,7 Efficacy of other vasodilators has been questioned because of problems with tolerance, side effects, or inability to ameliorate clinical status despite hemodynamic improvement. [15][16][17] Of the presently available vasodilators, only those with venodilating ability, such as nitrates and angiotensin-converting enzyme inhibitors, have produced sustained hemodynamic effects, increased exercise tolerance, and improved symptomatic status in controlled trials in patients with heart failure. 11 6 Thus there is a continuing interest in developing a nitrate delivery system that circumvents the problems of first-pass hepatic metabolism and limited duration of action of nitrates.…”