Chronic Sympathetic Suppression in the Treatment of Chronic Congestive Heart Failure

• Published in: Clinical and experimental hypertension (1993) 1998, Vol.20 (7), p.717-731
• Main Authors: Manolis, Athanasios J., Olympios, Christoforos, Sifaki, Maria, Smirnioudis, Nicholas, Handanis, Stelios, Argirakis, Spyridon, Katsaros, Constantine, Gavras, Irene, Gavras, Haralambos
• Format: Article
• Language: English
• Subjects: Administration, Oral; ambulatory ECG; Biological and medical sciences; Cardiology. Vascular system; Catecholamines - blood; Chronic Disease; Clonidine; Clonidine - adverse effects; Clonidine - therapeutic use; Echocardiography; Electrocardiography, Ambulatory; Exercise Test; exercise tolerance; Female; Heart; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Rate - drug effects; Humans; Male; Medical sciences; Middle Aged; Neural Inhibition - physiology; Prospective Studies; Renin - blood; Sympathetic Nervous System - drug effects; Sympathetic Nervous System - physiopathology; Sympatholytics - adverse effects; Sympatholytics - therapeutic use; Vasopressins - blood
• ISSN: 1064-1963; 1525-6006
• DOI: 10.3109/10641969809052115

Previous short-term studies demonstrated that treatment with clonidine produced significant hemodynamic improvement in patients with congestive heart failure (CHF). In this study we followed 12 CHF patients (10 M, 2 F age 63 ± 11, 10 with ischemic cardiomyopathy and 2 with dilated cardiomyopathy) treated with 0.15 or 0.075 mg oral clonidine twice daily for 13 ± 5 months (range 6-23), with functional evaluation at baseline, 6 weeks and 6 months. There was suppression of circulating cateholamines, associated with significant ameliorations in NYHA class, in duration of exercise tolerance (from 246 ± 68 sec to 362 ± 30 and 459 ± 70 sec, respectively p < 0.02), in ejection fraction (from 32 ± 7% to 35 ± 5 and 39 ± 7% p < 0.04) and in left ventricular enlargement as assessed echocardiographically. There were also improvements in a number of electrophysiologic parameters calculated by computerized analysis of ambulatory ECG tapes, such as heart rate variability, indicating diminished propensity to malignant arrhythmias, as confirmed by decreases in the numbers of isolated premature ventricular contractions, couplets and episodes of non-sustained ventricular tachycardia. The data suggest that chronic central sympathetic suppression with clonidine in CHF results in significant functional amelioration and improved electrophysiologic stability.