Nitrate resistance and tolerance: potential limitations in the treatment of congestive heart failure.
Organic nitrates are commonly used in the treatment of chronic congestive heart failure (CHF). These drugs have been shown to improve exercise capacity and reduce symptoms and in combination with hydralazine to prolong life in patients with mild-to-moderate symptoms of CHF. Recent investigations, however, have indicated that nitrate-mediated benefit to patients with CHF may be limited by resistance to their hemodynamic effects seen in many patients and by early development of tolerance. The incidence, potential mechanisms, and possible methods for prevention of nitrate resistance and tolerance in patients with chronic CHF are reviewed.
Elkayam
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U
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033.
Mehra
A
A
Shotan
A
A
Ostrzega
E
E
D004334:Drug Administration Schedule; D004351:Drug Resistance / Q000502:physiology; D004361:Drug Tolerance / Q000502:physiology; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009566:Nitrates / Q000627:therapeutic use*
D009566:Nitrates