Vasodilators for mitral valve regurgitation

Examples

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Brand Name	Generic Name
Apresazide [contains a diuretic]	hydralazine hydrochloride

Angiotensin-converting enzyme (ACE) inhibitors:

Brand Name	Generic Name
Lotensin	benazepril

Brand Name	Generic Name
Capoten	captopril

Brand Name	Generic Name
Vasotec	enalapril

Brand Name	Generic Name
Monopril	fosinopril

Brand Name	Generic Name
Zestril	lisinopril

Brand Name	Generic Name
Accupril	quinapril

Brand Name	Generic Name
Altace	ramipril

Brand Name	Generic Name
Mavik	trandolapril

Angiotensin II receptor blockers (ARBs):

Brand Name	Generic Name
Atacand	candesartan cilexetil

Brand Name	Generic Name
Avapro	irbesartan

Brand Name	Generic Name
Hyzaar	losartan

Nitrates:

Brand Name	Generic Name
Isordil	isosorbide dinitrate

Brand Name	Generic Name
Nitropress	nitroprusside (used in acute MR)

How It Works

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Vasodilators work on different substances in the body to help widen (dilate) blood vessels.

Why It Is Used

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Vasodilators are used for mitral valve regurgitation (MR) because the wider blood vessel will reduce resistance in blood flow and make it easier for blood to move forward from the left atrium to the left ventricle to the aorta. This helps reduce the amount of blood that leaks backward through the valve into the left atrium.

How Well It Works

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Data support the use of vasodilators for those with acute and chronic MR when the left ventricle is enlarged. But there are no data to support using vasodilators in mitral valve regurgitation with no symptoms or with normal ventricular function.¹

Side Effects

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Hydralazine may lower blood pressure, which may cause symptoms of dizziness, weakness, fainting, or fluid retention. People whose blood pressure is low when they start therapy will generally be started with a low dose and may need close monitoring to avoid reducing blood pressure too much. Hydralazine may also result in an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); numbness, tingling, pain, or weakness of arms or legs; irregular or very fast heartbeat; new or chest pain or chest pain getting worse; or fainting.

ACE inhibitor side effects may include:

• Dry cough.
• Rash or itching.
• Symptoms that are like allergy symptoms.
• Allergic reaction with generalized swelling (angioedema) or, in rare cases, swelling of the upper airway.
• Excess potassium in the body (hyperkalemia), especially in people with kidney failure.

ACE inhibitors may interact with anti-inflammatory medicines, antacids, potassium supplements, certain diuretics, and lithium.

ARB side effects may include:

• Diarrhea.
• Stomach problems.
• Muscle cramps.
• Back and leg pain.
• Dizziness.
• Insomnia.
• Nasal congestion.
• Sinus problems.
• Upper respiratory infection.

Nitrate side effects may include:

• Feeling of pulsating fullness in the head (most common side effect), which can also cause headache.
• Drop in blood pressure, which can cause dizziness.
• Burning sensation under the tongue (with sublingual nitroglycerin).

Nitroprusside may cause severe enough to cause death. Using too much too quickly may result in cyanide levels that the body cannot dispose of, leading to cyanide poisoning. Nitroprusside is generally only used in acute mitral regurgitation in patients who are hospitalized.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Nitroprusside should not be used in acute MR if the person with MR already has low blood pressure, because this medicine may further decrease blood pressure.

ACE inhibitors must be used carefully in people with severe kidney failure caused by diabetic nephropathy. A low dose is tried first. Potassium levels and kidney function are watched closely as the dose is increased.

Although vasodilators are used in acute MR, the benefits of using them for chronic MR are less clear.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84–e231.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Updated	March 27, 2008