Beneficial long-term effects of hydralazine in aortic regurgitation

The long-term effects of vasodilators in asymptomatic patients with aortic regurgitation have not been studied extensively. We retrospectively reviewed the echocardiograms of 19 asymptomatic patients with significant aortic regurgitation followed up annually for up to 4 years (average +/- SD, 3.1 +/- 0.7 years). Of these 19 patients, 12 were not receiving vasodilators and 7 were receiving hydralazine hydrochloride, 40 to 200 mg daily. In the patients not receiving vasodilators, left ventricular diastolic and systolic dimensions increased progressively in all patients by an average of 8% and 13%, respectively, after 3 years. In the patients receiving hydralazine, left ventricular dimensions increased by 9% and 5% in the year or more before hydralazine use and decreased by 7% and 7%, respectively, during the first year after using hydralazine. The reduction was observed in all patients during the first year, but an increase was detected in 3 patients followed up beyond that period. The results suggest that the progression of left ventricular dilatation in asymptomatic patients with aortic regurgitation can be delayed by long-term therapy with vasodilators. Pending further confirmation, such therapy may possibly influence the natural history of the disease and delay the timing of operation.