Author + information
- Divya Gupta, MD∗,
- Vasiliki V. Georgiopoulou, MD∗,
- Andreas P. Kalogeropoulos, MD∗,
- Catherine N. Marti, MD∗,
- Clyde W. Yancy, MD, MSc†,
- Mihai Gheorghiade, MD†,
- Gregg C. Fonarow, MD‡,
- Marvin A. Konstam, MD§ and
- Javed Butler, MD, MPH∗∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Javed Butler, Emory Cardiovascular Clinical Research Institute, 1462 Clifton Road NE, Suite 504, Atlanta, Georgia 30322.
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.
Dr. Gheorghiade is a consultant to Bayer, Novartis, Takeda, Medtronic, and Johnson & Johnson. Dr. Konstam is a consultant to Merck, Novartis, Amgen, Johnson & Johnson, and Otsuka; and has received grant support from Merck, Novartis, Amgen, Johnson & Johnson, and Otsuka. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 26, 2013.
- Accepted March 4, 2013.
- American College of Cardiology Foundation
- Nitrate Tolerance and Pseudotolerance
- Hydralazine Use and Nitrate Tolerance
- Problems With Hydralazine Therapy
- RAAS and Nitrate Tolerance
- Effect of Concomitant ACE Inhibitor and Nitrate Therapy
- Vasodilation With ACE Inhibitors Versus Hydralazine
- Other Heart Failure Therapies and Nitrate Tolerance
- Future Research