Effects and development of tolerance using transdermal nitrates in the treatment of congestive heart failure

Vasodilator therapy is an accepted mode of treating patients with severe congestive heart failure (CHF). Nitrates have a predominantly beneficial effect on preload, but also afterload may be beneficially modulated with higher doses. There is some evidence that long-term treatment with isosorbide dinitrate is beneficial in patients with CHF. By contrast, recent reports of 24 hour hemodynamics following transdermal delivery seem disappointing and rapid development of tolerance has been observed.