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Potassium Nitrate in Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.

Payman Zamani¹, Sanjiv J Shah², Jordana B Cohen¹

¹Perelman School of Medicine, University of Pennsylvania, Philadelphia.

JAMA Cardiology

|December 18, 2024

Summary

Chronic inorganic nitrate supplementation did not improve exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF). This study found no significant benefits in aerobic capacity or quality of life.

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Area of Science:

Cardiology and Exercise Physiology
Cardiovascular Research
Nitrate Supplementation Studies

Background:

Nitric oxide deficiency is implicated in exercise intolerance in heart failure with preserved ejection fraction (HFpEF).
Previous pilot studies suggested potential benefits of inorganic nitrate for exercise tolerance in HFpEF.

Purpose of the Study:

To evaluate the effect of chronic inorganic nitrate administration on exercise tolerance in a larger cohort of HFpEF patients.
To assess if long-term nitrate supplementation can enhance aerobic capacity and quality of life in HFpEF.

Main Methods:

A multicenter, randomized, double-blinded, crossover trial involving symptomatic HFpEF patients.
Participants received either potassium nitrate (KNO3) or potassium chloride (KCl) for 6 weeks, with a 1-week washout period.
Primary endpoints included peak oxygen uptake and total work performed during cardiopulmonary exercise testing.

Main Results:

Potassium nitrate increased serum nitric oxide metabolites but did not significantly improve peak oxygen uptake or total work performed.
No significant improvements were observed in exercise systemic vasodilatory reserve or quality of life (Kansas City Cardiomyopathy Questionnaire).
The inorganic nitrate intervention was well-tolerated by participants.

Conclusions:

Chronic administration of potassium nitrate did not enhance aerobic capacity, exercise performance, or quality of life in patients with HFpEF.
These findings suggest that inorganic nitrate supplementation may not be an effective strategy for improving exercise intolerance in this population.
Further research is needed to explore alternative therapeutic approaches for HFpEF.