Evidence supporting the use of: Nitrate (unspecified)
For the health condition: Congestive Heart Failure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Nitrates, such as nitroglycerin and isosorbide dinitrate, have scientific validation for use in supporting and treating congestive heart failure (CHF), particularly in acute decompensated heart failure and in specific chronic heart failure regimens. Nitrates act as vasodilators, primarily by donating nitric oxide, which leads to relaxation of vascular smooth muscle, resulting in venodilation and, to a lesser extent, arterial dilation. This reduces both preload (venous return to the heart) and, at higher doses, afterload (arterial resistance), thereby decreasing cardiac workload and myocardial oxygen demand. In acute settings, intravenous nitrates can rapidly relieve symptoms such as pulmonary congestion and edema by reducing filling pressures. Several clinical trials, including the landmark V-HeFT (Vasodilator-Heart Failure Trial), have demonstrated the efficacy of a combination of hydralazine and isosorbide dinitrate in reducing mortality and improving symptoms in patients with heart failure, particularly among African American populations. Nitrates are not usually first-line therapy for chronic CHF but are often used adjunctively, especially for patients with persistent symptoms despite standard therapy or those intolerant to other medications. Their role is less prominent now due to the advent of therapies like ACE inhibitors, beta-blockers, and ARBs, but their utility remains established in guidelines. Side effects and tolerance (tachyphylaxis) can limit their long-term use. Overall, the evidence base is robust, though not as strong as for some newer agents, justifying a high but not maximal evidence score.

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