Nitrates versus angiotensin-converting enzyme inhibitors for congestive heart failure

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Abstract

The efficacy of nitrates versus that of angiotensin-converting enzyme (ACE) inhibitors in heart failure may be evaluated based on 3 treatment aims: hemodynamic improvement, symptom relief, and survival benefit. Nitrates used in conjunction with hydralazine produce a relatively large increase in stroke volume and a prominent reduction of left ventricular filling pressure, whereas ACE inhibitors produce a comparatively modest increase in stroke volume with a prominent reduction in filling pressure. The effect of these drugs on arterial compliance has been evaluated using a modified Windkessel model of the circulation to define their mechanism of action. Nitrates appear to affect the large arteries and arterial bed as well as the venous circulation. Intermediate-term response to therapy is often evaluated by changes in exercise tolerance. A review of multicenter trials reveals that, although both ACE inhibitors and hydralazine/nitrate have favorable hemodynamic actions, the effect of hydralazine/nitrate on exercise capacity appears to be slightly better. ACE inhibitors and nitrates both may reduce dysfunctional myocardial remodeling, as evaluated in a canine model of chronic left ventricular dysfunction. The increase in the ejection fraction by these drugs and the decrease of plasma norepinephrine levels by ACE inhibitors may contribute to improved long-term survival. It appears, therefore, that the long-term benefits of nitrates and ACE inhibitors in heart failure probably relate to their ability both to affect cardiac remodeling and to relax vascular smooth muscle.

Original languageEnglish (US)
JournalThe American journal of cardiology
Volume72
Issue number8
DOIs
StatePublished - Sep 9 1993

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Angiotensin-Converting Enzyme Inhibitors
Nitrates
Heart Failure
Hydralazine
Stroke Volume
Hemodynamics
Exercise Tolerance
Left Ventricular Dysfunction
Ventricular Pressure
Vascular Smooth Muscle
Pharmaceutical Preparations
Compliance
Multicenter Studies
Canidae
Norepinephrine
Arteries
Pressure

Cite this

Nitrates versus angiotensin-converting enzyme inhibitors for congestive heart failure. / Cohn, Jay N.

In: The American journal of cardiology, Vol. 72, No. 8, 09.09.1993.

Research output: Contribution to journalArticle

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