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Current perspectives on hydralazine and nitrate therapies in heart failure

Robert T Cole1, Divya Gupta1, Javed Butler1

  • 1Division of Cardiology, Emory University, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA.

Heart Failure Clinics
|September 14, 2014
PubMed

Insights

Hydralazine/isosorbide dinitrate (H+ISDN) therapy, originating from the V-HeFT I trial, offers benefits beyond vasodilation, potentially through nitroso-redox balance. This effective heart failure treatment remains underutilized, necessitating improved education.

Area of Science:

  • Cardiology
  • Pharmacology
  • Heart Failure Management

Background:

  • The hydralazine/isosorbide dinitrate (H+ISDN) combination therapy's origins trace back to the V-HeFT I clinical trial.
  • Initially prescribed for balanced vasodilation, its mechanism of action is now understood to involve nitroso-redox balance maintenance.

Purpose of the Study:

  • To re-evaluate the established benefits of H+ISDN in heart failure management.
  • To highlight the underutilization of H+ISDN therapy despite its proven efficacy.

Main Methods:

  • Review of the V-HeFT I trial and subsequent research on H+ISDN.
  • Analysis of the pharmacological mechanisms, including nitroso-redox balance.

Main Results:

  • H+ISDN therapy provides benefits beyond simple vasodilation.
  • Despite decades of research and established efficacy, H+ISDN remains significantly underutilized in clinical practice.

Conclusions:

  • The nitroso-redox balance may be the key mechanism driving H+ISDN's benefits in heart failure.
  • Enhanced physician and patient education is crucial to increase the appropriate use of H+ISDN therapy.

Keywords:
Congestive heart failureHydralazineNitratesVasodilators

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