Nitrate therapy for heart failure. Benefits and strategies to overcome tolerance

Divya Gupta; Vasiliki V. Georgiopoulou; Andreas P. Kalogeropoulos; Catherine N. Marti; Clyde W. Yancy; Mihai Gheorghiade; Gregg C. Fonarow; Marvin A. Konstam; Javed Butler

doi:10.1016/j.jchf.2013.03.003

Nitrate therapy for heart failure. Benefits and strategies to overcome tolerance

Divya Gupta
, Vasiliki V. Georgiopoulou
, Andreas P. Kalogeropoulos
, Catherine N. Marti
, Clyde W. Yancy
, Mihai Gheorghiade
, Gregg C. Fonarow
, Marvin A. Konstam
, Javed Butler

Department of Medicine - Division of Cardiology

Emory University
Northwestern University
University of California at Los Angeles
Tufts University

Research output: Contribution to journal › Review article › peer-review

33 Scopus citations

Abstract

Combination therapy with hydralazine and nitrates can improve outcomes in patients with heart failure and low ejection fraction. However, this combination is underused in clinical practice for several reasons, including side effects related to hydralazine and polypharmacy. Some of the benefits seen with hydralazine, including afterload reduction and attenuation of nitrate tolerance, have also been observed with angiotensin-converting enzyme inhibitors. Demonstrating similar clinical benefits with nitrates plus angiotensin-converting enzyme inhibitor therapy alone, in the absence of hydralazine, may represent an opportunity to improve heart failure care by increasing the use of nitrates. In this paper, we summarize data that support studying such an approach.

Original language	English
Pages (from-to)	183-191
Number of pages	9
Journal	JACC: Heart Failure
Volume	1
Issue number	3
DOIs	https://doi.org/10.1016/j.jchf.2013.03.003
State	Published - Jun 2013

Keywords

Heart failure
Hydralazine
Nitrate
Pseudotolerance
Renin angiotensin aldosterone system
Tolerance

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10.1016/j.jchf.2013.03.003

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title = "Nitrate therapy for heart failure. Benefits and strategies to overcome tolerance",

abstract = "Combination therapy with hydralazine and nitrates can improve outcomes in patients with heart failure and low ejection fraction. However, this combination is underused in clinical practice for several reasons, including side effects related to hydralazine and polypharmacy. Some of the benefits seen with hydralazine, including afterload reduction and attenuation of nitrate tolerance, have also been observed with angiotensin-converting enzyme inhibitors. Demonstrating similar clinical benefits with nitrates plus angiotensin-converting enzyme inhibitor therapy alone, in the absence of hydralazine, may represent an opportunity to improve heart failure care by increasing the use of nitrates. In this paper, we summarize data that support studying such an approach.",

keywords = "Heart failure, Hydralazine, Nitrate, Pseudotolerance, Renin angiotensin aldosterone system, Tolerance",

author = "Divya Gupta and Georgiopoulou, \{Vasiliki V.\} and Kalogeropoulos, \{Andreas P.\} and Marti, \{Catherine N.\} and Yancy, \{Clyde W.\} and Mihai Gheorghiade and Fonarow, \{Gregg C.\} and Konstam, \{Marvin A.\} and Javed Butler",

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AU - Gupta, Divya

AU - Georgiopoulou, Vasiliki V.

AU - Kalogeropoulos, Andreas P.

AU - Marti, Catherine N.

AU - Yancy, Clyde W.

AU - Gheorghiade, Mihai

AU - Fonarow, Gregg C.

AU - Konstam, Marvin A.

AU - Butler, Javed

PY - 2013/6

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AB - Combination therapy with hydralazine and nitrates can improve outcomes in patients with heart failure and low ejection fraction. However, this combination is underused in clinical practice for several reasons, including side effects related to hydralazine and polypharmacy. Some of the benefits seen with hydralazine, including afterload reduction and attenuation of nitrate tolerance, have also been observed with angiotensin-converting enzyme inhibitors. Demonstrating similar clinical benefits with nitrates plus angiotensin-converting enzyme inhibitor therapy alone, in the absence of hydralazine, may represent an opportunity to improve heart failure care by increasing the use of nitrates. In this paper, we summarize data that support studying such an approach.

KW - Heart failure

KW - Hydralazine

KW - Nitrate

KW - Pseudotolerance

KW - Renin angiotensin aldosterone system

KW - Tolerance

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DO - 10.1016/j.jchf.2013.03.003

M3 - Review article

C2 - 24621868

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SN - 2213-1779

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SP - 183

EP - 191

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ER -

Nitrate therapy for heart failure. Benefits and strategies to overcome tolerance

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Keywords

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