Physiologic and pharmacologic determinants of vasodilator response: a conceptual framework for rational drug therapy for chronic heart failure.

This article has attempted to summarize the increasing number of pharmacologic and physiologic variables that are being recognized as important determinants in the response to vasodilator therapy in patients with severe chronic heart failure. It is apparent that a careful consideration of many factors is necessary before proper selection of a specific drug can be made for a specific patient, since not all patients with refractory heart failure demonstrate beneficial hemodynamic and clinical responses to all agents. Each patient presents us with a unique set of physiologic variables; each drug has its own advantages and limitations. Identification of those subgroups of patients most likely to benefit from a specific agent or combination of agents is a major goal for future research. Although a number of hemodynamic variables can be made to improve acutely with a wide variety of vasodilator drugs, well tolerated sustained meaningful clinical benefits are probably observed in relatively few patients. Rational and successful vasodilator therapy is possible only through a highly individualized approach.