Vasodilators for mitral valve regurgitation

Examples

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

Angiotensin-converting enzyme (ACE) inhibitors:

Generic Name	Brand Name
benazepril	Lotensin
captopril	Capoten
enalapril	Vasotec
fosinopril	Monopril
lisinopril	Prinivil, Zestril
quinapril	Accupril
ramipril	Altace
trandolapril	Mavik

Angiotensin II receptor blockers (ARBs):

Generic Name	Brand Name
candesartan cilexetil	Atacand
irbesartan	Avapro
losartan	Cozaar, Hyzaar

Nitrates:

Generic Name	Brand Name
isosorbide dinitrate	Dilatrate-SR, Isordil, Sorbitrate
nitroprusside (used in acute MR)	Nipride, Nitropress

How It Works

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

Why It Is Used

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

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

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

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.

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Author:	Robin Parks, MS	Last Updated: March 27, 2008
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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