Effect of vasodilator and inotropic drugs on clinical symptoms and long-term survival in chronic congestive heart failure.

The major therapeutic goals in the treatment of congestive heart failure are the relief of symptoms and the prolongation of life, but it remains unclear whether there is a relation between changes in exercise tolerance and alterations in the risk of death. Although all vasodilator and inotropic agents produce short-term haemodynamic benefits, these acute effects do not predict the long-term clinical responses to these drugs. Converting-enzyme inhibitors appear to improve symptoms and survival. A combination of hydralazine and isosorbide dinitrate produces variable effects on exercise tolerance but appears to prolong life. Catecholamines and phosphodiesterase inhibitors may reduce dyspnea and fatigue but adversely affect mortality. Calcium channel blocking drugs may exert deleterious effects on both symptoms and prognosis. alpha-Adrenergic blocking drugs produce no beneficial or adverse effects on clinical status or mortality. Hence, there is no consistent relation between the symptomatic and prognostic effects of drug therapy in patients with chronic heart failure. This variability makes it impossible to predict the effects of any drug on exercise tolerance or survival based on an evaluation of the agent's short-term haemodynamic effects.