[Do vasodilators help in chronic heart failure?]

The value of vasodilator drugs in the treatment of patients with chronic congestive heart failure is reviewed on the basis of the randomized double-blind, placebo-controlled trials so far published. Apparently, venous, or combined venous and arteriolar dilation in addition to cardiac glycosides and diuretics may produce long-term improvement in advanced stages of heart failure. Vasodilators with isolated afterload reducing properties seem to be of limited value. Long-term improvement with nitrates and alpha-receptor blocking agents is often modest, probably due to development of tolerance. The most striking results were observed with converting enzyme inhibitors: they evoke virtually no tolerance, improve haemodynamics at rest and during exercise, relieve symptoms of heart failure and are even suggested to reduce mortality.