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Usefulness of nicorandil in congestive heart failure
1Istituto di Malattie dell'Apparato Cardiovascolare, Università di Bologna, Italy.
Insights
Nicorandil, a vasodilator, significantly reduced blood pressure and pulmonary artery pressures in patients with congestive heart failure (CHF). These beneficial hemodynamic effects persisted for up to 8 hours post-administration.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is a complex condition affecting cardiac function.
- Nicotinamide-nitrate vasodilators represent a class of drugs with potential therapeutic applications in cardiovascular diseases.
Purpose of the Study:
- To evaluate the hemodynamic and hormonal effects of nicorandil in patients with moderate to severe CHF.
- To assess the impact of nicorandil on rest and exercise hemodynamics and key hormonal markers.
Main Methods:
- A double-blind, randomized trial involving 9 patients with New York Heart Association class II/III CHF.
- Administration of single oral doses of placebo, 40 mg, and 60 mg of nicorandil.
- Hemodynamic measurements (blood pressure, pulmonary pressures) at rest and during exercise, alongside forearm blood flow, venous capacitance, plasma noradrenaline, and plasma renin activity assessments.
Main Results:
- Nicorandil significantly decreased mean blood pressure, mean pulmonary artery pressure, and mean pulmonary wedge pressure at rest.
- These reductions in hemodynamic parameters were observed up to 6 to 8 hours after both 40 mg and 60 mg doses.
- Peak effects on hemodynamics were noted between 30 and 60 minutes post-dose.
Conclusions:
- Nicorandil demonstrates significant and sustained hemodynamic benefits in patients with congestive heart failure.
- The drug effectively reduces both systemic and pulmonary pressures, suggesting a potential role in managing CHF symptoms.
Abstract:
Rest and exercise hemodynamic and hormonal effects of nicorandil, a nicotinamide-nitrate vasodilator, were assessed in 9 patients with New York Heart Association class II or III congestive heart failure (CHF) and left ventricular ejection fraction less than or equal to 40%. Single oral doses of placebo and 40 and 60 mg of nicorandil were given in a double-blind, randomized trial. Hemodynamic measurements were assessed at rest, up to 8 hours after dose and at peak exercise performed on an upright cycloergometer 1 hour after the dose. Forearm blood flow and venous capacitance were measured by plethysmography 45 minutes after dose. Plasma noradrenaline and plasma renin activity were assessed 1 hour and 2 hours after dose, respectively. Data were analyzed by analysis of variance. Peak effects were observed between 30 and 60 minutes after dose. Mean blood pressure decreased from 86 +/- 7 mm Hg after placebo to 78 +/- 7 mm Hg after 40 mg (p less than 0.05) and to 78 +/- 7 mm Hg after 60 mg (p less than 0.05) of nicorandil. Mean pulmonary artery pressure decreased from 24 +/- 11 to 15 +/- 17 mm Hg (p less than 0.05) and to 17 +/- 7 mm Hg (p less than 0.05) and mean pulmonary wedge pressure decreased from 15 +/- 8 to 9 +/- 4 mm Hg (p less than 0.05) and to 10 +/- 5 mm Hg (p less than 0.05). The changes were significant up to 6 to 8 hours after both doses.(ABSTRACT TRUNCATED AT 250 WORDS)