CardioScipts Classic – Vasodilators in HFrEF [Part 1]

Dr. Robert Page and CardioScripts co-host, Dr. Tracy Macaulay, take a deep dive into classic literature pertaining to use of vasodilators in HFrEF.

0:00-0:47: Intro

0:41-1:23: Introduction of Dr. Robert Page

1:23-2:16: Intro of the Classic Episode Format

2:17-6:48: Foundation of HFrEF pharmacotherapy prior to 1986 and discussion of the V-HeFT I trial

6:48-9:12: CONSENSUS Trial and introduction of ACE-I as gold standard afterload reducer in HFrEF

9:12-12:34: V-HeFT II trial discussion.  A comparison of Hydralazine/Nitrate to Enalapril, solidification of ACE-I role.

12:34-13:46: Using other forms of nitrate in combination with hydralazine for HFrEF

13:47-20:28: Role of hydralazine/nitrate for African American patients with HFrEF withh discussion of A-HeFT trial

20:29-21:08: We ran out of time to cover ALL our conversation, so join us next time for Episode 2 with Dr. Page discussing vasodilators in HFrEF! 

References:

• V-HEFT: Cohn JN, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. The New England Journal of Medicine. 1986. 314(24):1547-52.
• ALLHAT: Wright JT, et al. Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs. Diuretic. Journal of the American Medical Association. 2002. 288(23):2981-2997.
• CONSENSUS Trial Study Group. “Effects of enalapril on mortality in severe congestive heart failure, results of the cooperative north Scandinavian enalapril survival study”. The New England Journal of Medicine. 1987. 316(23):1429-35.
• V-HEFT-II: Cohn JN, et al. “A Comparison of Enalapril with Hydralazine–Isosorbide Dinitrate in the Treatment of Chronic Congestive Heart Failure”. The New England Journal of Medicine. 1991. 325(5):303-310.
• SAVE: Pfeffer MA, et al. “Effect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction after Myocardial Infarction — Results of the Survival and Ventricular Enlargement Trial”. The New England Journal of Medicine. 1992. 327(10):669-677.
• Carson P, Ziesche S, Johnson G, Cohn JN, for the Vasodilator-Heart Failure Trial Study Group. Racial differences in response to therapy for heart failure: analysis of the Vasodilator-Heart Failure Trials. J Cardiac Failure. 1999. 5:178–187.
• A-HeFT: Taylor AL, et al. Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure. The New England Journal of Medicine. 2004. 351(20):2049-2057.
• SOLVD: Yusuf S, et al. Effect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart Failure. The New England Journal of Medicine. 1991. 325(5):293-302.
• Tam SW, Worcel M, Sabolinski ML, Packer M, Cohn JN.  Lack of bioequivalence between different formulations of isosorbide dinitrate and hydralazine and the fixed-dose combination of isosorbide dinitrate/hydralazine. The V-HeFT paradox. Clin Pharmacokinet  2007. 46:885–895.