Cohn J N, Franciosa J A
Am J Med. 1978 Jul;65(1):181-8. doi: 10.1016/0002-9343(78)90708-8.
Vasodilator and inotropic drugs work through independent mechanisms in augmenting left ventricular pump function in patients with heart failure. The selection between these two classes of pharmacologic agents for an individual patient may be based on the control blood pressure as well as the underlying disease. Although vasodilator drugs are easiest and safest to employ in patients with normal or high arterial presure levels, even in relatively hypotensive subjects (systolic arterial pressure less than 105 mm Hg), a salutary hemodynamic effect can be achieved without an undue decrease in pressure. Inotropic drugs may be safest to administer to patients without coronary artery disease, but the oxygen-consuming effect of these drugs need not necessarily have an adverse effect on patients with ischemic heart disease. Combined vasodilator and inotropic drug therapy is the most potent pharmacologic means of restoring pump function in patients with severe heart failure. The long-term use of vasodilator and inotropic drugs in the treatment of heart failure is dependent on the availability of agents that will produce a sustained hemodynamic effect. Hydralazine, nitrates and prazosin have been employed alone or in combination and provide a promising approach to vasodilator treatment of heart failure. Better and more selective oral inotropic agents are needed to allow this therapeutic modality to be employed optimally.
血管扩张剂和正性肌力药物通过独立的机制增强心力衰竭患者的左心室泵功能。对于个体患者，在这两类药物之间进行选择可能基于血压控制以及潜在疾病。尽管血管扩张剂在动脉压正常或较高的患者中使用最为简便和安全，但即使在相对低血压的患者（收缩压低于105 mmHg）中，也能在不过度降低血压的情况下实现有益的血流动力学效应。对于无冠状动脉疾病的患者，使用正性肌力药物可能最为安全，但这些药物的耗氧作用不一定会对缺血性心脏病患者产生不利影响。联合使用血管扩张剂和正性肌力药物是恢复重度心力衰竭患者泵功能最有效的药物手段。在心力衰竭治疗中，长期使用血管扩张剂和正性肌力药物取决于能否获得能产生持续血流动力学效应的药物。肼屈嗪、硝酸盐和哌唑嗪已单独或联合使用，为心力衰竭的血管扩张剂治疗提供了一种有前景的方法。需要更好、更具选择性的口服正性肌力药物，以使这种治疗方式得到最佳应用。
