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European Heart Journal 1990 11(12):1059-1064;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Long-term effect of isosorbide dinitrate and nifedipine, singly and in association, in patients with chronic heart failure

V. JEZ EK, J. JEZKOVÁ, A. MICHALIANI{caron}, P. NIEDERLE and R. FEUEREISH

Institute of Physiological Regulations, Czechoslovak Academy of Sciences Prague, Czechoslovakia

Received 1 March 1989; revised 3 January 1990; .

Correspondence: Vlastimil Jez ek, MD, ÚFR CSAV, Hospital Bulovka, 180 85 Prague 8, Czechoslovakia.

Abstract

The effect of 2-month treatment with isosorbide dinitrate (120 mg day–1), nifedipine (2x 20 mg day–1) and their combination has been assessed in 16 patients with mild to moderate chronic cardiac failure. Isosorbide dinitrate decreased right atrial ( – 23%), pulmonary wedge ( –20%) and pulmonary arterial (–17%) pressures but did not significantly change either cardiac output or systemic and pulmonary vascular resistance. Nifedipine increased cardiac output (+13%) and decreased systemic and pulmonary vascular resistance (both –17%) with no change of pressures. Combined therapy with both drugs decreased ventricular filling pressures ( –8% and –15%), systemic ( –20%) and pulmonary ( –13%) arterial pressures, increased cardiac output ( + 26%) and decreased both systemic ( –29%) and pulmonary (– 29%) vascular resistances. Changes during exercise were almost the same as at rest. The effect of both drugs was more pronounced in patients with more severely pathological haemodynamic measurements before treatment.

We conclude that combined treatment with both preload- and afterload-reducing agents can preserve or even potentiate a favourable haemodynamic effect of individual drugs.

Key Words: Chronic heart failure • pulmonary hypertension • isosorbide dinitrate • nifedipine


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