VASODILATORS IN HEART-FAILURE - CONCLUSIONS FROM V-HEFT-II AND RATIONALE FOR V-HEFT-III

The Veterans Affairs Vasodilator-Heart Failure Trials (V-HeFT I and II ) provided information about heart failure treated with conventional t herapy, and evaluated the long term efficacy of vasodilators. In V-HeF T I, the combination of hydralazine and isosorbide dinitrate provided a beneficial effect on prognosis in heart failure. V-HeFT II demonstra ted that enalapril had a more favourable effect on 2-year survival tha n a combination of hydralazine plus isosorbide dinitrate. However, the hydralazine-isosorbide dinitrate combination exerted the most favoura ble short term impact on exercise performance and left ventricular eje ction fraction. The V-HeFT studies showed that, although not all vasod ilators are alike, their differing effects might be beneficial when us ed in combination. Determination of the potential additive effect of t he calcium antagonist felodipine, a vasodilator, when used in combinat ion with an ACE inhibitor, is the major goal of V-HeFT III.