Vasodilators for mitral valve regurgitation

Examples

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Brand Name	Chemical Name
Apresoline	hydralazine hydrochloride

Angiotensin-converting enzyme (ACE) inhibitors:

Brand Name	Chemical Name
Lotensin	benazepril

Brand Name	Chemical Name
Capoten	captopril

Brand Name	Chemical Name
Vasotec	enalapril

Brand Name	Chemical Name
Monopril	fosinopril

Brand Name	Chemical Name
Zestril	lisinopril

Brand Name	Chemical Name
Accupril	quinapril

Brand Name	Chemical Name
Altace	ramipril

Brand Name	Chemical Name
Mavik	trandolapril

Nitrates:

Brand Name	Chemical 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 in those with acute and chronic MR when the left ventricle is enlarged. However, 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 worsening chest pain; or fainting.

ACE inhibitors may cause a dry cough, allergy symptoms, rash or itching, allergic reaction with generalized swelling (angioedema), and excess potassium in the body (hyperkalemia), especially in people with kidney failure.

ACE inhibitors may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium.

Nitroprusside may cause severe low blood pressure leading to 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 medication 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.²

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. Otto CM (2001). Evaluation and management of chronic mitral regurgitation. New England Journal of Medicine, 345(10): 740–746.

2. Bonow RO, Braunwald E (2004). Valvular heart disease. In DP Zipes et al,. eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., pp. 1553–1632. Philadelphia: Elsevier Saunders.

Credits

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Author	Kathe Gallagher, MSW
Author	Cynthia Tank
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Updated	April 3, 2006