Afterload reduction has been recommended in the management of systolic heart failure since the 1980s. Afterload= arterial resistance as blood is pumped out of the left ventricle. The thought is that by reducing afterload, cardiac filling pressures are decreased, which is beneficial.
What agents reduce afterload? Anything that is an arterial vasodilator. (Venodilators decrease preload, which are thought to have a similar beneficial effect.)
- Nitrates (venous>arterial vasodilators)
- Hydralazine (most selective arterial vasodilator, in my experience this has been used the most)
- Minoxidil (arterial vasodilator)
- Lisinopril, captopril (about equal veno- and arterial vasodilators)
- Diuretics (long-term arterial vasodilator)
- In the ICU: nitroprusside, phentolamine, dopamine
- Inotropes like milrinone (patients with advanced heart failure may be put on this palliatively)
- Technically, the intra-aortic balloon pump (IABP) does, too!