Add-On Hydralazine and Isosorbide Dinitrate in Ambulatory Patients with Advanced Heart Failure: Potential Improvements in Secondary Pulmonary Hypertension

Abstract

Background: Patients with advanced heart failure, particularly those with secondary pulmonary hypertension, often progress despite optimal medical therapy including ACE- Inhibitors and beta-blockers. Add-on fixed-dose hydralazine and nitrates (H/I) has been utilized in African American patients with symptomatic heart failure to reduce morbidity and mortality. We examined the potential of oral H/I as add-on therapy to improve hemodynamics in the ambulatory setting. Methods: We reviewed 62 consecutive ambulatory patients with advanced heart failure (LVEF <40%, NYHA III-IV) with at least two right heart catheterizations (RHC) for symptoms evaluation at the Cleveland Clinic.