Nitrate therapy for congestive heart failure
J. A. Franciosa, L. A. Nordstrom and J. N. Cohn
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.
