Cohn J N
Department of Medicine, University of Minnesota Medical School, Minneapolis.
Am J Cardiol. 1987 Nov 16;60(15):39H-43H. doi: 10.1016/0002-9149(87)90550-9.
The systemic vasoconstriction that is characteristic of patients with congestive heart failure involves arteriolar constriction, reduction in arterial compliance and reduction in venous capacitance, all of which contribute to the increased impedance and increased preload that aggravate the hemodynamic abnormality. Nitrates are effective in increasing arterial compliance and venous capacitance and thus have a favorable acute hemodynamic effect in heart failure. Long-term studies suggest that this favorable effect is maintained in response to high dose oral isosorbide dinitrate therapy and that it is associated with relief of symptoms and improved exercise tolerance. When combined with hydralazine, isosorbide dinitrate therapy has been shown in the Veterans Administration study to prolong survival in patients with class II and III congestive heart failure. Therefore, long-term nitrate therapy appears to have an important potential in patients with heart failure. It may now be appropriate to use nitrates not only to relieve symptoms, but also to improve long-term outlook in this syndrome.
充血性心力衰竭患者的典型全身血管收缩涉及小动脉收缩、动脉顺应性降低和静脉容量减少，所有这些都导致阻抗增加和前负荷增加，从而加重血液动力学异常。硝酸盐可有效增加动脉顺应性和静脉容量，因此对心力衰竭具有良好的急性血液动力学效应。长期研究表明，高剂量口服硝酸异山梨酯治疗可维持这种良好效应，且与症状缓解和运动耐量改善相关。在退伍军人管理局的研究中，硝酸异山梨酯与肼苯哒嗪联合治疗已被证明可延长II级和III级充血性心力衰竭患者的生存期。因此，长期硝酸盐治疗似乎对心力衰竭患者具有重要潜力。现在不仅使用硝酸盐来缓解症状，而且改善该综合征的长期预后可能是合适的。
