Nitrates Updated: Current Use in Angina, Ischemia, Infarction and Failure

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 topical book is authored by experts in the field of nitrate research and experienced clinicians, and is a reflection of what is truly current in that remarkable group of fundamental cardiovascular drugs: the nitrates.