Acute and chronic effects of oral hydralazine on left ventricular pump function and renal hemodynamics in chronic left heart failure

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Abstract
To test the acute and chronic, effects, of oral hydralazine (HD) on left ventricular (LV) pump function and renal hemodynamics, we administered it to patients with chronic left heart failure. After 6 days of HD- therapy (n = 12), there was a striking increase in cardiac index (P < 0.001) averaging 50% of control, which was fully maintained over a 6 month, period of chronic HD-therapy (n = 6, P < 0.001). Improvement in pump function was associated with a marked, chronically sustained fall in systemic vascular resistance (−43% after 6 days, P < 0.001, −40% after 6 months, P < 0.01). Despite the significant increase in cardiac index, renal perfusion did not change acutely under HD. After 6 months, however, a 32% increase in renal perfusion was found accompanying the persistent improvement in cardiac performance (P < 0.01). Our data suggest that oral HD is equally effective during acute and chronic application in patients with left heart failure. After short-term HD therapy, no increase in renal perfusion occurs, perhaps due to renal vasoconstriction involving, the renin-angiotensin system. Chronically, however, HD improves renal perfusion, as it controls heart failure.

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