Vasodilators for heart failure--useful or useless?

Vasodilators have gained widespread acceptance in the management of congestive heart failure. They produce prompt hemodynamic and clinical improvement in acute left ventricular failure, and in chronic congestive heart failure they also improve symptoms, functional capacity, and survival. This efficacy, however, is limited to those vasodilators which have venodilating ability, such as nitrates and angiotensin-converting enzyme inhibitors, when they are added to digitalis and diuretics in patients with moderate to severe heart failure. The utility of vasodilators without digitalis or diuretics requires further evaluation. The potential for vasodilators to prevent the development or progression of heart failure from latent to clinically overt disease is also being evaluated.