Haemodynamic Effects of Long-Term Prazosin Therapy in Patients with Congestive Heart Failure

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Abstract
The haemodynamic effects of prazosin were studied over a period of 6 months in 10 patients with chronic congestive heart failure. All patients were on digoxin and diuretics. In the whole group, mean pulmonary artery pressure decreased by an average of 30% at rest as well as during exercise, whereas cardiac output remained unchanged despite a significant decrease of the arteriovenous oxygen difference. In only 4 of 10 patients did we observe a significant increase in cardiac output, particularly during exercise. Heart rate and blood pressure were unchanged. Plasma prazosin concentrations ranged from 9.4 to 58.6 ng/ml. In 8 of 10 patients an improvement of dyspnea was observed after 6 months of prazosin therapy. Side effects in terms of hypotension, urinary incontinence, and sexual impotence were noted in 4 patients. No patient developed positive antinuclear factor. We conclude that prazosin exerts beneficial haemodynamic effects after 6 months of therapy in patients with severe left heart failure; these consist mainly in a reduction of pulmonary congestion with a minor effect on cardiac output. The decrease in the arteriovenous oxygen difference may be explained by peripheral arteriovenous shunting. Prazosin is considered a valuable adjunct in the therapy of chronic heart failure with predominant pulmonary congestion.

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