Nitrates in heart failure

Hydralazine now has little use long-term for hypertension, but it may have a role as a vasodilator (plus nitrates) in heart failure. It reduces peripheral resistance by directly relaxing arterioles, with negligible effect on veins. In common with all potent arterial vasodilators, its hypotensive action is accompanied by a compensatory baroreceptor-mediated sjmpathetic discharge, causing tachycardia and increased cardiac output. There is also renin release with secondary salt and water retention,... 

Tolerance can limit the long-term effectiveness of nitrates in the treatment of CHF. Blood levels of these drugs should be permitted to fall to negligible levels for at least 6-8 hours each day, which can be adjusted to the patient s symptoms. Patients with recurrent orthopnea or paroxysmal nocturnal dyspnea, for example, would likely benefit most by using nitrates at night. N-acetylcysteine (mucomyst) may diminish tolerance to the hemodynamic effects of nitrates in heart failure. Likewise, hydralazine may decrease nitrate tolerance by an antioxidant effect that attenuates superoxide formation, thereby increasing NO bioavailability. 

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See also in sourсe #XX -- [ ]

See also in sourсe #XX -- [ ]

See also in sourсe #XX -- [ , ]

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