Circulation, Vol 82, 1954-1961, Copyright © 1990 by American Heart Association
U Elkayam, J Amin, A Mehra, J Vasquez, L Weber and SH Rahimtoola
We performed a prospective, randomized, double-blind, crossover study to
compare the efficacy and safety of vasodilation with the calcium entry
blocker nifedipine with that of isosorbide dinitrate (ISDN) and their
combination as treatment for heart failure. Twenty-eight patients with New
York Heart Association Functional class II or III chronic heart failure due
to left ventricular systolic dysfunction were studied. All patients were
maintained on a constant dose of digitalis and diuretics throughout the
study. Eight weeks of therapy with nifedipine alone or in combination with
ISDN resulted in a significantly higher incidence of heart failure
deterioration necessitating hospitalizations and/or additional diuretics.
Twenty-four percent of patients required hospitalization during nifedipine
therapy and 26% required hospitalization during nifedipine-ISDN combination
therapy in comparison to 0% requiring hospitalization during ISDN therapy
alone. The total number of heart failure-worsening episodes was nine among
patients on nifedipine, three among patients on ISDN (p less than 0.09
versus nifedipine), and 21 among patients on nifedipine-ISDN combination (p
less than 0.001 versus nifedipine, p less than 0.0001 versus ISDN).
Premature discontinuation of drug administration due to clinical
deterioration or other side effects occurred in 29% of patients during
nifedipine therapy, 5% of patients during ISDN therapy (p = 0.05 versus
nifedipine), and 19% of patients during the combination therapy. A
comparison of eight patients who demonstrated clinical deterioration on
nifedipine with the remainder of the patients demonstrated no significant
difference in left ventricular ejection fraction (0.24 +/- 0.06 versus 0.23
+/- 0.07) or maximal oxygen uptake during exercise (13 +/- 3 versus 14 +/-
2 ml/kg/min).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
A prospective, randomized, double-blind, crossover study to compare the efficacy and safety of chronic nifedipine therapy with that of isosorbide dinitrate and their combination in the treatment of chronic congestive heart failure
Department of Medicine, University of Southern California School of Medicine 90033.
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