Angiotensin-converting enzyme (ACE) inhibitors:
Angiotensin II receptor blockers (ARBs):
|nitroprusside (used in acute MR)
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
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
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:
ACE inhibitors may interact with anti-inflammatory
medicines, antacids, potassium supplements, certain diuretics, and
ARB side effects may
Nitrate side effects may
- 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 is generally only used for acute
mitral regurgitation in the hospital. If nitroprusside is used, you are closely watched, because this medicine may cause severe low blood pressure.
Reference for a full list of side effects. (Drug Reference is not available in
What To Think About
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.
vasodilators are used in acute MR, the benefits of using them for chronic MR
are less clear.
If you are pregnant or may become pregnant, do not take ACE inhibitors or ARBs. If you are pregnant or breast-feeding or if you may become pregnant, talk to your doctor before you take other vasodilator medicines. These medicines may be harmful to a fetus or to a baby who is breast-feeding.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for
the management of patients with valvular heart disease. A report of the
American College of Cardiology/American Heart Association Task Force on
Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the
Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84-e231.