Nitrates as Adjuvant Therapy for Chronic Congestive Heart Failure

  • J. A. Franciosa


Nitrates have been used to treat angina pectoris for more than a century, and long- acting nitrates such as isosorbide dinitrate (ISDN) are regarded as effective drugs for prophylactic use to reduce the number and severity of anginal attacks in patients with coronary heart disease. There is also ample evidence that nitrates produce beneficial hemodynamic effects as well as clinical effects in patients with heart failure [1-5]. There are still, however, many remaining questions concerning mechanism of action and dosage schedules and the role of nitrates relative to other vasodilators. Since virtually all studies of nitrates in heart failure have been carried out in patients already taking digitalis and diuretics to which nitrates were added, we really have essentially no information on nitrates as initial therapy for heart failure.


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  1. 1.
    Franciosa JA, Mikulic E, Cohn JN, Jose E, Fabie A (1975) Hemodynamic effects of orally administered isosorbide dinitrate in patients with congestive heart failure. Circulation 52: 477–482PubMedGoogle Scholar
  2. 2.
    Bussman W, Lohner J, Kaltenbach M (1977) Orally administered isosorbide dinitrate in patients with and without left ventricular failure due to acute myocardial infarction. Am J Cardiol 39: 91–96CrossRefGoogle Scholar
  3. 3.
    Franciosa JA, Nordstrom LA, Cohn JN (1978) Nitrate therapy for congestive heart failure. JAMA 240: 443–146PubMedCrossRefGoogle Scholar
  4. 4.
    Franciosa JA, Goldsmith SR, Cohn JN (1980) Contrasting acute and chronic effects of nitrates on exercise capacity in heart failure. Am J Med 69: 559–566PubMedCrossRefGoogle Scholar
  5. 5.
    Leier CV, Huss PM, Magorien RD, Unverferth DV (1983) Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. Circulation 67: 817–822PubMedCrossRefGoogle Scholar
  6. 6.
    Rubin SA, Chatterjee K, Parmley WW (1980) Metabolic assessment of exercise in chronic heart failure patients treated with short-term vasodilators. Circulation 61: 543–548PubMedGoogle Scholar
  7. 7.
    Maskin CS, Forman R, Sonnenblick EH, Frishman WH, Lejemtel TH (1983) Failure of dobutamine to increase exercise capacity despite hemodynamic improvement in severe chronic heart failure. Am J Cardiol 51: 177–182PubMedCrossRefGoogle Scholar
  8. 8.
    Cohn JN, Archibald D, Ziesche S, Franciosa JA, Harston WE, Tristani F, Dunkman B, Jacobs W, Francis G, Flohr K, Goldman S, Cobb F, Shah P, Saunders R, Fletcher R, Loeb H, Hughes V, Baker B (1986) Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study (V-HEFT). N Engl J Med (in press)Google Scholar
  9. 9.
    Franciosa JA, Weber KT, Levine TB, Kinasewitz GT, Janicki JS, West J, Henis MMJ, Cohn JN (1982) Hydralazine in the long-term treatment of chronic heart failure: lack of difference from placebo. Am Heart J 104: 587–594PubMedCrossRefGoogle Scholar
  10. 10.
    Franciosa JA, Jordan RA, Wilen MM, Leddy CL (1984) Minoxidil in patients with chronic left heart failure: contrasting hemodynamic and clinical effects in a controlled trial. Circulation 70: 63–68PubMedCrossRefGoogle Scholar
  11. 11.
    The Captopril Multicenter Research Group (1983) A placebo-controlled trial of captopril in refractory congestive heart failure. J Am Coll Cardiol 2: 755–763CrossRefGoogle Scholar
  12. 12.
    Franciosa JA, Wilen MM, Jordan RA (1985) Effects of enalapril, a new angiotensin-converting enzyme inhibitor, in a controlled trial in heart failure. J Am Coll Cardiol 5: 101–107PubMedCrossRefGoogle Scholar
  13. 13.
    Levine TB, Olivari MT, Garberg V, Sharkey SW, Cohn JN (1984) Hemodynamic and clinical response to enalapril, a long-acting converting enzyme inhibitor, in patients with congestive heart failure. Circulation 69: 548–558PubMedCrossRefGoogle Scholar
  14. 14.
    Franciosa JA, Dunkman WB, Leddy CL (1984) Hemodynamic effects of vasodilators and longterm response in heart failure. J Am coll Cardiol 3: 1521–1530PubMedCrossRefGoogle Scholar
  15. 15.
    Franciosa JA (1979) Functional capacity of patients with chronic left ventricular failure: relationship of bicycle exercise performance to clinical and hemodynamic characterization. Am J Med 67: 460–466PubMedCrossRefGoogle Scholar
  16. 16.
    Franciosa JA, Park M, Levine TB (1981) Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am J Cardiol 47: 33–39PubMedCrossRefGoogle Scholar
  17. 17.
    Engler R, Ray R, Higgins CB, McNally C, Buxton WH, Bhargava V, Shabetai R (1982) Clinical assessment and follow-up of functional capacity in patients with chronic congestive cardiomyopathy. Am J Cardiol 49: 1832–1837PubMedCrossRefGoogle Scholar
  18. 18.
    Higginbotham MB, Morris KG, Conn EH, Coleman RE, Cobb FR (1983) Determinants of variable exercise performance among patients with severe left ventricular dysfunction. Am J Cardiol 51: 52–60PubMedCrossRefGoogle Scholar
  19. 19.
    Baker BJ, Wilen MM, Boyd CM, Dinh H, Franciosa JA (1984) Relation of right ventricular ejection fraction to exercise capacity in chronic left ventricular failure. Am J Cardiol 54: 596–599PubMedCrossRefGoogle Scholar
  20. 20.
    Franciosa JA, Baker BJ, Seth L (1985) Pulmonary versus systemic hemodynamics in determining exercise capacity of patients with chronic left ventricular failure. Am Heart J 110: 807–813PubMedCrossRefGoogle Scholar
  21. 21.
    Korr KS, Gandsman EJ, Winkler ML, Shulman RS, Bouth EW (1982) Hemodynamic correlates of right ventricular ejection fraction measured with gated radionuclide angiography. Am J Cardiol 49: 71–77PubMedCrossRefGoogle Scholar
  22. 22.
    Franciosa JA, Wilen M, Ziesche S, Cohn JN (1983) Survival in men with severe chronic left ventricular failure due to either coronary heart disease or to idiopathic dilated cardiomyopathy. Am J Cardiol 51: 831–836PubMedCrossRefGoogle Scholar
  23. 23.
    Unverferth DV, Magorien DR, Moeschberger ML, Baker PB, Fetters JK, Leier CV (1984) Factors influencing the one year mortality of dilated cardiomyopathy. Am J Cardiol 54: 147–152PubMedCrossRefGoogle Scholar
  24. 24.
    Chatterjee K, Parmley WW, Massie B, Greenberg B, Werner J, Klausner S, Norman A (1976) Oral hydralazine therapy for chronic refractory heart failure. Circulation 54: 879–883PubMedGoogle Scholar
  25. 25.
    Szlachcic J, Massie B, Kramer B, Topic N, Tubau J (1985) Exercise tolerance predicts early mortality in patients with heart failure (Abstr). J Am Coll Cardiol 5: 513Google Scholar
  26. 26.
    Franciosa JA, Wilen MM, baker BJ (1983) Functional capacity and long-term survival in chronic left ventricular failure (Abstr). Circulation 68 (Suppl III): 111–149Google Scholar
  27. 27.
    Parker JO, Fung HL, Ruggirello D, Stone JA (1983) Tolerance to isosorbide dinitrate: rate of development and reversal. Circulation 68: 1074–1080PubMedCrossRefGoogle Scholar
  28. 28.
    Abrams J (1984) The brief saga of transdermal nitroglycerin discs: paradise lost? Am J Cardiol 54: 220–224PubMedCrossRefGoogle Scholar
  29. 29.
    Jordan RA, Seth L, Casebolt P, Hayes MJ, Wilen MM, Franciosa J (1986) Rapidly developing tolerance to transdermal nitroglycerin in congestive heart failure. Ann Intern Med 104: 295–298PubMedGoogle Scholar
  30. 30.
    Franciosa JA, Blank RC, Cohn JN, Mikulic E (1977) Hemodynamic effects of topical, oral, and sublingual nitroglycerin in left ventricular failure. Curr Ther Res 22: 231–245Google Scholar
  31. 31.
    Olivari MT, Carlyle PF, Levine B, Cohn JN (1983) Hemodynamic and hormonal response to transdermal nitroglycerin in normal subjects and in patients with congestive heart failure. J Am Coll Cardiol 2: 872–878PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • J. A. Franciosa
    • 1
  1. 1.Cardio-renal Drugs, Stuart PharmaceuticalsICI Americas Inc.WilmingtonUSA

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