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Jacob Zatuchni, MD
Pennsylvania Hospital Temple University School of Medicine Philadelphia

JAMA. 1988;260(17):2510.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In the treatment of chronic congestive heart failure, Mulrow et al¹ concluded that all vasodilators except hydralazine hydrochloride were associated with improved functional status. However, "feeling better" usually occurred early and was not sustained. Moreover, combined therapy with nitrates and hydralazine offered no protective benefit, and therapy with nitrates alone was associated with a trend to increased (sic) mortality. In studies evaluating -antagonists, the longest trial (six months) found no significant functional improvement either early or late. In those given angiotensin converting enzyme inhibitors, a significant protective effect was found but individuals who profited most could not be identified. Moreover, questions were raised in the minds of the authors about causality of any benefit of angiotensin converting enzyme inhibitors because control groups were not balanced according to amount of diuretics employed. Finally, this study is a metaanalysis, without contact with a single patient and based only . . . [Full Text PDF of this Article]

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