beta blockade, or hypertension despite ACE inhibitors, beta
blockers and diuretics. Yet with the convincing evidence for real
benefits from beta blockade in heart failure, the DHPs should
probably only be used, even for these limited indications, if beta
blockade is contraindicated.
The inotropic dilators (“inodilators”) such as amrinone and
milrinone are very useful in acute heart failure, but are not safe in
chronic heart failure, as warned by the FDA because of the risks
of increased hospitalisation and mortality.^4
RReeffeerreenncceess
1 Gogia H, Mehra A, Parikh S et al. Prevention of tolerance to hemo-
dynamic effects of nitrates with concomitant use of hydralazine in
patients with chronic heart failure. J Am Coll Cardiol1995; 2266 : 1575–80.
2 Packer M, O’Connor CM, Ghali JK et al. Effect of amlodipine on
morbidity and mortality in severe chronic heart failure. Prospective
Randomized Amlodipine Survival Evaluation Study Group. N Engl J
Med1996; 333355 : 1107–14.
3 Mohler ER, Sorensen LC, Ghali JK et al. Role of cytokines in the mech-
anism of action of amlodipine: the PRAISE Heart Failure Trial.
Prospective Randomized Amlodipine Survival Evaluation. J Am Coll
Cardiol1997; 3300 : 35–41.
4 Thadani U, Roden DM. FDA Panel Report. Circulation1998; 9977 : 2295–6.