Hemodynamic study of short- and long-term isradipine treatment in patients with chronic ischemic congestive heart failure.

The acute hemodynamic effects of isradipine on cardiac performance, at rest and during exercise, were examined in nine male patients aged 37 to 69 years with congestive heart failure due to ischemic heart disease. The effects of 10 mg oral isradipine were maximal after two to three hours with significant decreases in blood pressure as well as in systemic and pulmonary vascular resistances, and an increase in cardiac output. There were no significant changes in heart rate or pulmonary capillary wedge pressure. For the same 50-watt bicycle workload pre- and post-drug, the addition of isradipine was associated with lower systemic and pulmonary vascular resistances (systemic vascular resistance, 805 +/- 70 versus 975 +/- 70; p less than 0.01; pulmonary vascular resistance, 144 +/- 27 versus 207 +/- 35 dynes.sec.cm-5; p less than 0.01), and lower pulmonary artery pressures (54 +/- 6/23 +/- 3 versus 66 +/- 7/27 +/- 3 mm Hg; p less than 0.01) during exercise. In a double-blind 12-week trial, body weight decreased during isradipine treatment (71.6 to 68.9 kg; p less than 0.01), but there were no significant changes in exercise duration, radionuclide ejection fraction, or cardiothoracic ratio, and no serious side effects were encountered. These results suggest that isradipine is worthy of further evaluation in long-term treatment of chronic ischemic congestive heart failure.