Hydralazine is a smooth muscle relaxant and a potent arteriolar dilator. The major hemodynamic effect of hydralazine in patients with heart failure are increased cardiac output and stroke volume, and decreased vascular resistance without any significant change in pulmonary and systemic venous pressure. Hydralazine also produces beneficial hemodynamic effects in patients with mitral and aortic regurgitation and in some patients with large ventricular septal effect with reduced systemic output. However, the role of long-term hydralazine therapy in these patients remains uncertain. In many patients with chronic heart failure with low cardiac output, hydralazine produces sustained beneficial hemodynamic and clinical effects. The long-term prognosis of patients with chronic heart failure, however, remains unchanged, although certain subsets of patients appear to have better prognoses than others during long-term hydralazine therapy.