[Lack of symptomatic and long-term hemodynamic effects of prazosin in chronic heart failure. Double-blind, randomized...

Long-term treatment of congestive heart failure with prazosin is disputed. Only few controlled trials have been reported so far. Our study is the first randomized double-blind placebo controlled trial over several months that also takes haemodynamic measurements into account. 25 patients with congestive heart failure classes III and IV (NYHA) received either prazosin 20 mg/d orally (n = 12) or placebo (n = 13) and were followed up closely. Before treatment, after 6 and after 12 months we performed echocardiography, heart volume (estimated by chest X-ray) and right heart catheterization at rest and during exercise. No significant differences could be noticed during follow-up concerning the following parameters: symptoms (NYHA), left ventricular end-diastolic diameter, shortening fraction, heart volume and systemic vascular resistance. While diuretics could be reduced in 3 patients with placebo an increasing dose was necessary in 6 out of 12 patients of the prazosin group. Long-term treatment of congestive heart failure with prazosin may be valuable only in exceptional cases.