Haemodynamic effects of nifedipine in heart failure.

Nifedipine, a calcium antagonist with strong vasodilatating effects, has been successfully used in the treatment of angina pectoris. To investigate if it can be used as a vasodilator in patients with congestive heart failure, nifedipine 20 mg was administered sublingually to 11 patients with chronic heart failure. The clinical diagnosis was congestive cardiomyopathy in 10 and severe mitral regurgitation in one patient. All patients were studied haemodynamically and in 10 ofthem an angiographic study was also performed. Nifedipine lowered mean systemic arterial pressure (from 95-0 5.3 to 75-2 43-6 mmHg), mean pulmonary arterial pressure (from 37-9±3-1 to 28-0±2t4 mmHg), mean pulmonary capillary wedge pressure (from 25-2+20 to 16.7± 1.7 mmHg), left ventricular end-diastolic pressure (from 22-6± 1-8 to 14 2i 1 7 mmHg), and systemic vascular resistance (from 1967 +247 to 1108 146 dynes s cm-5). Simultaneously all indices of left ventricular performance improved: cardiac index rose from 2 12±011 to 3 11±0-301/M2 per min, ejection fraction increased from 0-26±0'02 to 0-41±+0-05 per cent, and stroke volume index rose from 32-2±1-9 to 46-8±3-4ml/m2. Left ventricular end-diastolic volume index and end-systolic volume index both diminished (from 137'2± 14-0 to 128-1 i 14-3 ml/m2 and from 104.9 ± 13.6 to 81'3 + 14-7 ml/m2, respectively). No significant changes in heart rate were noted, whereas