Nitrates in heart failure.

Organic nitrates have been used widely in the treatment of chronic congestive heart failure. These drugs have been shown to have beneficial hemodynamic effects both at rest and during dynamic and isometric exercise. In combination with hydralazine, nitrates have been shown to improve exercise tolerance, enhance left ventricular ejection fraction, and prolong survival. The potential limitations of nitrate therapy are related to dose-related nitrate resistance and the development of nitrate tolerance. More information is needed regarding the usefulness of nitrate therapy without hydralazine and the additional benefits of these drugs in patients already treated with angiotensin converting enzyme inhibitors.