Nitrates Updated

The chief current clinical indications for the use of nitrates remain ischemic heart disease in all its manifestations, and as adjuvant therapy in congestive heart failure. One study has shown a 17% fall in mortality when IV nitrates are combined with the ACE inhibitor lisinopril. Nitrates alone had no effect, and lisinopril alone reduced mortality by 12%, so it is logical to propose that the ACE inhibitor reduces or minimizes nitrate tolerance. Second, it has recently been suggested that concurrent treatment with hydralazine avoids or lessens nitrate tolerance in the treatment of congestive heart failure, thus explaining the sustained effect exerted by nitrates when given concurrently with hydralazine. This review of current research in th euse of nitrates as cardiovascular drugs covers such topics as: mechanisms of action of nitrates; Short and long-acting oral nitrates for stable angina pectoris; Nitrates in myocardial infarction; and nitrates in congestive heart failure.