Highlights
- •Acute heart failure (AHF) is associated with poor prognosis and high mortality.
- •Mortality benefits of vasodilators in AHF are not established and lack evidence.
- •Well-designed and large-scale trials are needed to establish firm conclusions.
- •The results of trials on vasodilators such as serelaxin are expected.
Abstract
Acute heart failure (AHF) contributes largely to the worldwide burden of heart failure
(HF) and is associated with high mortality, poor prognosis and high rehospitalization
rate. The pharmacologic therapy of AHF includes diuretics and vasodilators, which
are a keystone when fluid overload and congestion are present. However, vasodilators
are mainly focused on controlling symptoms, and drugs that also improve long-term
mortality and morbidity seem to be in high demand. In this review, we summarize the
existing evidence on mortality benefits of IV vasodilators in AHF.
There is lack of evidence on the mortality benefits of IV vasodilators in AHF, as
well as well-designed and large-scale trials for some of them. The existing trials
on nitrates have conflicting results and are insufficient to establish definitive
conclusions. Other vasodilators, such as enalaprilat, clevidipine, carperitide, and
ularitide, have been evaluated only in a few trials assessing mortality. Levosimendan,
nesititide and carperitide are approved by some regulatory agencies; however, data
regarding mortality are also conflicting and large-scale post-marketing studies would
be important. Serelaxin is a recent therapy with a novel mechanism of action and seemed
to be promising; although serelaxin was safe and well tolerated in earlier trials,
the results of a larger phase III trial failed to meet the primary endpoints of reduction
in cardiovascular death at day 180 and reduction of worsening heart failure at day
5.
The absence of definitive mortality benefits and high-quality and large-scale data
not allow firm conclusions to be drawn about the role of IV vasodilators in AHF. Well-designed
studies are needed to clarify the role of these drugs in the long-term outcome of
AHF, as well as new therapies entering the clinical investigation.
Keywords
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Article info
Publication history
Published online: February 24, 2018
Accepted:
February 21,
2018
Received in revised form:
February 4,
2018
Received:
September 3,
2017
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
