[Nitrates in the treatment of congestive heart failure].

In this revision article, after referring the mechanisms of action of nitrates in the relief of heart failure symptoms, the author presents the results of the controlled studies which show the beneficial effect of the nitrates on heart failure symptoms and mortality. The results of the therapy with nitrates are compared to other heart failure therapies, such as the administration of the angiotensin conversion enzyme (ACE) inhibitors. In spite of the highly favourable results regarding mortality shown by the latest studies with ACE inhibitors, the nitrates still occupy an essential place in the therapy of patients with heart failure, since they have the advantage of a much faster onset of action and are more effective in relieving symptoms than ACE inhibitors. Ancient problems of controversial clinical significance are focused such as resistance and tolerance to nitrates, its clinical implications, and possible methods for prevention of nitrate tolerance and resistance are reviewed. Finally, the author suggests some dosage and administration routes of the nitrates in heart failure, giving attention to particular clinical groups, namely the elderly and other special cases, and their adverse events.