1986Heart failure642 patients

V-HeFT I

Therapy group: Vasodilators · Therapy: Hydralazine + isosorbide dinitrate or prazosin vs placebo

In chronic heart failure, hydralazine plus isosorbide dinitrate trended toward lower mortality and improved ejection fraction, whereas prazosin showed no benefit.

Published in N Engl J Med (1986)

Question: Does adding a vasodilator to digoxin and a diuretic reduce mortality in patients with chronic congestive heart failure?
Design: Veterans Administration cooperative, randomized, double-blind, three-arm trial enrolling 642 men. Mean follow-up was 2.3 years (range, 6 months to 5.7 years).
Population: Men with impaired cardiac function and reduced exercise tolerance who were already taking digoxin and a diuretic.
Intervention: Prazosin (20 mg per day) or the combination of hydralazine (300 mg per day) plus isosorbide dinitrate (160 mg per day), in addition to background therapy.
Control: Placebo added to digoxin and a diuretic.
Primary outcome: Mortality over the entire follow-up; mortality at two years was a major end point specified in the protocol.
Results: Mortality risk reduction at two years with hydralazine plus isosorbide dinitrate was 34% (P < 0.028), with cumulative mortality of 25.6% vs 34.3% with placebo; at three years it was 36.2% vs 46.9%. Mortality with prazosin was similar to placebo. The difference in mortality over the entire follow-up was of borderline statistical significance.
Conclusion: Adding hydralazine and isosorbide dinitrate to digoxin and diuretics can improve left ventricular function and mortality in chronic heart failure, whereas prazosin showed no benefit.
Why it matters: It was one of the first trials to show that a vasodilator regimen could prolong survival in heart failure, laying the groundwork for the later development of neurohormonal therapy and for the use of this combination.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 18, 2026

Sources

Original publication on PubMed (PMID 3520315) ↗Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study.
Journal article (DOI) ↗

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