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Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction
Margaret M Redfield1, Kevin J Anstrom, James A Levine
1From the Mayo Clinic, Rochester, MN (M.M.R., B.A.B., H.H.C.); Duke Clinical Research Institute (K.J.A., S.E.M., E.J.V.) and Duke University Medical Center (G.M.F.) - both in Durham, NC; Mayo Clinic, Scottsdale, AZ (J.A.L., G.A.K.); University of Vermont Medical Center, Burlington (M.M.L.); Washington University School of Medicine, St. Louis (S.M.J.); Northwestern University, Chicago (S.J.S.); Massachusetts General Hospital (M.J.S.) and Harvard Medical School (E.B.) - both in Boston; Emory University, Atlanta (R.T.C.); Thomas Jefferson University, Philadelphia (G.R.R.); Johns Hopkins University School of Medicine, Baltimore (R.J.T.), and the National Heart, Lung, and Blood Institute, Bethesda (M.R.S.) - both in Maryland; and the Cleveland Clinic Foundation, Cleveland (W.H.W.T.).
Isosorbide mononitrate did not improve activity tolerance in patients with heart failure with preserved ejection fraction. This nitrate medication significantly reduced daily activity and hours of activity compared to placebo.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Nitrates are frequently prescribed for heart failure with preserved ejection fraction (HFpEF) to improve activity tolerance.
- The efficacy of isosorbide mononitrate in enhancing daily activity in HFpEF patients requires further investigation.
Purpose of the Study:
- To compare the effects of isosorbide mononitrate versus placebo on daily activity levels in patients with HFpEF.
- To evaluate the impact of isosorbide mononitrate on secondary endpoints including quality of life and exercise capacity.
Main Methods:
- A multicenter, double-blind, crossover study involving 110 HFpEF patients.
- Patients received escalating doses of isosorbide mononitrate (30-120 mg) or placebo for 6 weeks, followed by crossover.
- Daily activity was measured using accelerometers; secondary outcomes included 6-minute walk distance and NT-proBNP levels.
Main Results:
- Isosorbide mononitrate (120 mg) showed a trend toward lower daily activity and a significant decrease in hours of activity compared to placebo.
- Overall activity levels were significantly lower with isosorbide mononitrate across all doses compared to placebo.
- No significant differences were observed in 6-minute walk distance, quality of life, or NT-proBNP levels between groups.
Conclusions:
- Isosorbide mononitrate treatment in HFpEF patients resulted in reduced activity levels.
- The medication did not lead to improvements in quality of life or submaximal exercise capacity compared to placebo.
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