The Treatment of Heart Failure

Abstract

In this article literature concerning the major drugs used in the treatment of heart failure is reviewed. Because of major discrepancies in results from short term and uncontrolled studies versus long term randomised control trials, only the latter group of studies are addressed in detail. Of 3 randomised control trials of digoxin, 1 has been positive, and 2 negative. Digoxin is probably of benefit to a minority of heart failure patients. Four randomised control trials of oral nitrates have shown a reduction in left ventricular filling pressure, and trends favouring active treatment for the indices of exercise capacity and functional status. Of 2 randomised control trials of hydralazine one is totally negative, the other difficult to interpret because of major loss of patients to followup. Of 5 trials of quinazolone derivatives (prazosin and trimazosin), 2 have been positive, 2 showed non-statistically significant trends favouring active treatment, and 1 was completely negative. These results are consistent with a modest benefit of prazosin and trimazosin in some heart failure patients. Five trials of angiotensin-converting enzyme inhibitors (captopril and enalapril) have shown dramatic and consistent benefit in exercise capacity and functional status. These results support a clinical policy of initial treatment with diuretics and addition of either captopril or enalapril for patients who remain symptomatic on optimal diuretic therapy. A trial of digoxin is warranted in patients whose functional capacity remains reduced on this regimen.

Prevalence of Valvular Heart Disease and Pulmonary Hypertension in Children in Rantau-Prapat City, North Sumatra, Indonesia

“…They are more likely to have RHD, a condition typically rare in high-income countries, and are at higher risk of developing early cardiovascular disease, including VHD. [10] The tricuspid valve (TV), which was once overlooked, has recently gained increased attention.…”

Effects of Chronic Nitrate Therapy on Left-Ventricular Volume in Patients with Heart Failure Secondary to Coronary Disease Already Treated with Captopril: A Withdrawal Study

“…The patients were randomized to receive either a target dose of 40 mg isosorbide dinitrate twice daily or placebo in addition to captopril and diuretics at constant doses. A target dose of 40 mg isosorbide dinitrate was given [3]. The study drug was taken at 8 a.m. and 4 p.m. so that the problem of nitrate tolerance did not arise [7].…”

“…No ‘within-group’ analyses were carried out [3, 11]. The groups were compared with regard to baseline characteristics by the Wilcoxon-Mann-Whitney test.…”

“…Whether nitrates improve survival in this condition has never been investigated [2]. A number of studies have suggested that nitrates exert favorable hemodynamic effects [3]. The issue whether nitrates may supplement angiotensin-converting enzyme inhibitors is important, because in many patients with heart failure daily life is restricted in spite of standard therapy.…”

The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management

“…The spread of urbanization worldwide during the transition from agricultural to industrial activity and service economies is responsible for exposing increasing numbers of people to traditional and non-traditional cardiovascular risk factors, such as smoking, hypertension, obesity, diabetes, air pollution, and stress, which are strongly associated with VHD, as calcific AS [ 10 ]. As fertility rates fall below replacement levels in high-income countries and population aging increases, the need for young immigrant groups to supplement the workforce and provide support for the elderly becomes more pressing [ 10 ]. Socioeconomic deprivation is common in immigrant groups and is compounded by a range of health inequalities, many of which are indirect consequences of discrimination and racism [ 11 ].…”