[Therapy of chronic heart failure with vasodilators]

The chronic heart insufficiency is essentially characterized by a disturbed regulative function of the peripheral circulation. These processes taking place within efforts for compensation close the chain of the vicious circle. The vasodilators with their different principles of effect affect in various places of the vegetative nervous system up to the smooth musculature of the vessels and modulate the peripheral part of the cardiovascular system. Via a changed behaviour of the impedance also with the arterial vasodilation the ejection behaviour of the insufficed hearts changes. With the increase of the ejection fraction the filling pressure can decrease, also when only the arterial branch of the periphery of the vessels is influenced. In case of an additional vasodilation of the capacity vessels greater influences of the preload are present. As a rule after the full use of the conventional therapy with digitalis and saluretics is resorted to the adjuvant therapy with vasodilators. Good experiences in the therapy of chronic heart insufficiency are present above all for hydralazine and prazosin as well as increasingly also for captopril, when vasodilating and at the same time positively inotropic medicaments are disregarded. In future, depending upon haemodynamic and neurohumoral (PNA, PRAA) findings in problematic cases and aimed additional adjuvant therapy will be aspired to.