Evidence supporting the use of: Nitrate
For the health condition: Congestive Heart Failure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Nitrates, such as nitroglycerin and isosorbide dinitrate, are scientifically validated therapies used in the management of congestive heart failure (CHF), particularly in acute decompensated heart failure and in some chronic cases. These agents act as vasodilators, primarily by releasing nitric oxide, which relaxes vascular smooth muscle and leads to venodilation. This venodilation reduces preload (the amount of blood returning to the heart), thereby lowering myocardial oxygen demand and helping to relieve symptoms of congestion such as pulmonary edema.

The combination of hydralazine and isosorbide dinitrate has been shown in clinical trials (notably the African-American Heart Failure Trial, A-HeFT) to improve survival and quality of life in patients with heart failure with reduced ejection fraction (HFrEF), especially among African American patients. Nitrates alone are also commonly used for acute symptom relief in CHF exacerbations, though they are less frequently used as monotherapy for chronic heart failure. The mainstay of chronic CHF therapy remains ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists, but nitrate/hydralazine remains an important adjunct in selected populations.

In summary, the use of nitrates in CHF is supported by both pathophysiological rationale and clinical trial evidence, especially when used in combination with hydralazine, and for acute symptom management.

More about Nitrate
More about Congestive Heart Failure

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