Author + information
- Received January 3, 1983
- Revision received March 18, 1983
- Accepted March 30, 1983
- Published online August 1, 1983.
- Barry M. Massie, MD, FACC*,a,1,
- Milton Packer, MD, FACC†,2,
- J. Timothy Hanlon, MD, FACC‡ and
- D. Thomas Combs, MD, FACC‡
- ↵aAddress for reprints: Barry M. Massie, MD, Cardiology Service (111C), Veterans Administration Hospital, 4150 Clement Street, San Francisco, California 94121.
The hemodynamic benefits and safety of combined therapy with Captopril and hydralazine were studied during invasive hemodynamic monitoring in 14 patients with severe heart failure. In eight patients, the individual effects of both drugs were evaluated before the administration of combined therapy, whereas hydralazine was added to maintenance Captopril therapy in the other six patients. In the first group, Captopril alone produced a marked decrease in pulmonary wedge pressure (28 ± 4 to 18 ± 5 mm Hg) and mean arterial pressure (85 ± 20 to 69 ± 13 mm Hg) (both p < 0.001) without a significant increase in cardiac index. Hydralazine alone produced a marked increase in cardiac index (1.6 ± 0.4 to 2.7 ± 0.5 liters/min per m2) (p < 0.001), but with a minimal decrease in pulmonary wedge pressure (28 ± 4 to 23 ± 4 mm Hg) (p < 0.05) and without a significant change in mean arterial pressure.
The combination of Captopril and hydralazine produced an increase in cardiac index similar to that of hydralazine alone and decreases in pulmonary wedge pressure and mean arterial pressure similar to those with Captopril alone. Most important, when hydralazine was added to Captopril in the entire group of 14 patients, cardiac index increased markedly with little additional decrease in mean arterial pressure and no significant increase in heart rate. The one patient who experienced symptomatic hypotension with combination therapy also had dizziness with Captopril alone. Seven of the nine patients maintained on long-term treatment experienced symptomatic improvement. Thus, in patients with severe chronic heart failure, the combined use of Captopril and hydralazine is feasible and produces acute hemodynamic improvement superior to that from either drug alone.
↵1 Dr. Massie is a Clinical Investigator of the Veterans Administration, Washington, D.C.
↵2 Dr. Packer is the recipient of a Young Investigators' Award (R23-HL 25055) from the National Institutes of Health, Bethesda, Maryland.
This work was also supported by Grant HL 28146 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland
- Received January 3, 1983.
- Revision received March 18, 1983.
- Accepted March 30, 1983.
- American College of Cardiology Foundation