Franciosa J A, Nordstrom L A, Cohn J N
JAMA. 1978 Aug 4;240(5):443-6.
A randomized double-blind crossover trial included 16 patients with severe congestive heart failure who received isosorbide dinitrate or placebo for eight weeks, and then the opposite treatment for eight more weeks. All patients received their usual maintenance therapy with digitalis and diuretics. Seven morbid events occurred during 85 patient-weeks of isosorbide dinitrate therapy compared with 17 during 76 patient-weeks of placebo. Severity of congestive heart failure improved in all eight patients who received isosorbide dinitrate compared with two patients who showed improvement and five whose symptoms became worse with placebo. No significant differences in physical findings, cardiac dimensions, or resting hemodynamics were observed. Maximal exercise duration increased significantly by 2.54 minutes with isosorbide dinitrate therapy, and rose insignificantly by 1.24 minutes with placebo. This preliminary trial suggests that long-term vasodilator therapy may be clinically beneficial in congestive heart failure.
一项随机双盲交叉试验纳入了16例重度充血性心力衰竭患者，他们接受硝酸异山梨酯或安慰剂治疗8周，然后再接受相反的治疗8周。所有患者均接受洋地黄和利尿剂的常规维持治疗。在硝酸异山梨酯治疗的85个患者周期间发生了7起不良事件，而在安慰剂治疗的76个患者周期间发生了17起。与接受安慰剂治疗的2例病情改善、5例症状恶化的患者相比，接受硝酸异山梨酯治疗的8例患者的充血性心力衰竭严重程度均有所改善。在体格检查、心脏大小或静息血流动力学方面未观察到显著差异。硝酸异山梨酯治疗使最大运动持续时间显著增加2.54分钟，安慰剂治疗使最大运动持续时间无显著增加，仅增加1.24分钟。这项初步试验表明，长期血管扩张剂治疗可能对充血性心力衰竭具有临床益处。
