| Nitrates in the treatment of congestive heart failure. | |
| | |
MedLine Citation:
|
PMID: 8638526 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Nitrates have been widely used for the treatment of patients with chronic congestive heart failure. Although the use of these drugs has not been evaluated by large-scale studies traditionally used for evaluation of new therapy, multiple studies over the years have demonstrated their favorable effects. Organic nitrates have been shown to have a beneficial effect on ischemia, hemodynamic profile, magnitude of mitral regurgitation, endothelial function, and cardiac remodeling. These drugs alone or in combination with hydralazine have improved exercise capacity, maximal oxygen consumption, cardiac function, and survival. The use of nitrates in patients with heart failure has been limited by reduced responsiveness (resistance) and early development of tolerance. Nitrate resistance is due to reduced vascular response and results in the need to use a larger dose of any nitrate preparation when used for the treatment of patients with heart failure compared to patients without heart failure. Recent information suggests that nitrate tolerance is caused by increased levels of superoxide at the vascular wall, which leads to reduced nitric oxide level and to increased sensitivity to vasoconstrictive mechanisms, such as endothelin and angiotensin II. Intermittent dosing of nitrates allowing a 12-hour nitrate-free interval is effective in preventing nitrate tolerance and is, therefore, recommended. Recent information suggests that augmentation of nitrate dose by the use of an escalating dose regimen and a concomitant use of hydralazine can prevent or overcome the effect of nitrate tolerance in patients with heart failure. |
| | |
Authors:
|
U Elkayam |
Related Documents
:
|
20965876 - Urinary 8-hydroxy-2'-deoxyguanosine reflects symptomatic status and severity of systoli... 18814826 - Therapeutic implications of implantable device-based monitoring of patients with heart ... 7612986 - Assessment of ventricular function in dilated cardiomyopathies. 9654396 - Experimental cardiomyopathy as a model of chronic heart failure. 12455076 - Long balloon angioplasty with focal stenting for the treatment of diffuse coronary arte... 10817296 - Left ventricular function in adolescents and adults with restrictive ventricular septal... |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: The American journal of cardiology Volume: 77 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1996 May |
Date Detail:
|
Created Date: 1996-07-10 Completed Date: 1996-07-10 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 41C-51C Citation Subset: AIM; IM |
Affiliation:
|
Division of Cardiology, Department of Medicine, University of Southern California School of Medicne, Los Angeles 90033, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Drug Tolerance Heart Failure / drug therapy*, mortality Hemodynamics / drug effects Humans Mitral Valve Insufficiency / drug therapy Nitrates / adverse effects, therapeutic use* |
| Chemical | |
Reg. No./Substance:
|
0/Nitrates |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Organic nitrates: new formulations and their clinical advantages.
Next Document: The renin-angiotensin system in left ventricular remodeling.