Nitrates as Adjuvant Therapy for Chronic Congestive Heart Failure
Nitrates have been used to treat angina pectoris for more than a century, and long- acting nitrates such as isosorbide dinitrate (ISDN) are regarded as effective drugs for prophylactic use to reduce the number and severity of anginal attacks in patients with coronary heart disease. There is also ample evidence that nitrates produce beneficial hemodynamic effects as well as clinical effects in patients with heart failure [1-5]. There are still, however, many remaining questions concerning mechanism of action and dosage schedules and the role of nitrates relative to other vasodilators. Since virtually all studies of nitrates in heart failure have been carried out in patients already taking digitalis and diuretics to which nitrates were added, we really have essentially no information on nitrates as initial therapy for heart failure.
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