Pharmacological Management

Oral Nitrates and Hydralazine

Nitrates and hydralazine are vasodilators that reduce preload and afterload, respectively, thereby reducing myocardial workload and oxygen consumption.

Although studies have shown that a combination of isosorbide dinitrate and hydralazine improves survival in patients with chronic congestive heart failure,1-2 there is no evidence that oral or transdermal nitrates improve prognosis following MI.3

Nitrates continue to be first-line therapy for angina pectoris, but European guidelines do not advocate the use of either nitrates or hydralazine for secondary prevention following MI.3,4

References:

  1. Davies MK, Gibbs CR, Lip GYH. Management: diuretics, ACE inhibitors, and nitrates. In: Gibbs CR, Davies MK, Lip GYH, eds. ABC of heart failure. London: BMJ Books, 2003;25-28. 
  2. Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med 1986;314:1547-52. 
  3. van de Werf F, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008;29:2909-45. 
  4. Bassand J-P, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 2007;28:1598-660.
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