Combination of hydralazine and isosorbide dinitrate

# Overview

# Combination of hydralazine and isosorbide dinitrate

## Indications of Combination of hydralazine and isosorbide dinitrate

## Background
- The combination of hydralazine and nitrates is useful in patients with advanced heart failure and in particularly, when ACE inhibitors are not well tolerated.
- Hydralazine by itself is only an arterial vasodilator and does not reduce left ventricular filling pressures to the same extent as nitrates and ACE inhibitors do. In fact, when used alone it can stimulate sympathetic tone reflexively.  The combination of hydralazine and nitrates has been shown to decrease mortality as well as improve the left ventricular ejection fraction and exercise capacity in patients with heart failure. However the combination of hydralazine and nitrates has been found to be less effective than ACE inhibitors.
- The major of use of this combination is in those patients who are intolerant of ACE inhibitors.

# Dosing

# 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) 

## Combination of Hydralazine and Nitrates in Patients Presenting With Heart Failure (DO NOT EDIT) 
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-  Jump up to: 4.0 4.1 4.2 Carson P, Ziesche S, Johnson G, Cohn JN (1999). "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group". Journal of Cardiac Failure. 5 (3): 17887. PMID 10496190. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)CS1 maint: Multiple names: authors list (link)
-  Cohn JN (1993). "The Vasodilator-Heart Failure Trials (V-HeFT). Mechanistic data from the VA Cooperative Studies. Introduction". Circulation. 87 (6 Suppl): VI14. PMID 8500232. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
-  Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH (1986). "Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study". The New England Journal of Medicine. 314 (24): 154752. doi:10.1056/NEJM198606123142404. PMID 3520315. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)CS1 maint: Multiple names: authors list (link)
-  Loeb HS, Johnson G, Henrick A, Smith R, Wilson J, Cremo R, Cohn JN (1993). "Effect of enalapril, hydralazine plus isosorbide dinitrate, and prazosin on hospitalization in patients with chronic congestive heart failure. The V-HeFT VA Cooperative Studies Group". Circulation. 87 (6 Suppl): VI7887. PMID 8500244. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)CS1 maint: Multiple names: authors list (link)