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ARTICLE |

Vasodilators in Chronic Congestive Heart Failure FREE

Jacob Zatuchni, MD
JAMA. 1988;260(17):2510-2510. doi:10.1001/jama.1988.03410170058031
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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 α-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

REFERENCES

Mulrow CD, Mulrow JP, Linn WD, et al:  Relative efficacy of vasodilator therapy in chronic congestive heart failure: Implications of randomized trials . JAMA 1988;;259:3422-3426.
Cohn JN, Rector TS:  Vasodilator therapy for heart failure: What have we learned from controlled clinical trials? JAMA 1988;;259:3456-3457.

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Mulrow CD, Mulrow JP, Linn WD, et al:  Relative efficacy of vasodilator therapy in chronic congestive heart failure: Implications of randomized trials . JAMA 1988;;259:3422-3426.
Cohn JN, Rector TS:  Vasodilator therapy for heart failure: What have we learned from controlled clinical trials? JAMA 1988;;259:3456-3457.
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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