Mini review: The clinical avenues of combined hydralazine-nitrate in subjects with heart failure with reduced ejection fraction

Pharmacy Practice

  • Asim Ahmed Elnour1Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Abu Dhabi campus; AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates.
  • Adel Sadeq2Associate Professor, Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates.
  • Azza Ramadan3College of Pharmacy, Al Ain University, Abu Dhabi Campus; AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates.
  • Abdulla AlAmoodi4Ambulatory Healthcare Services, Academic Affairs, Abu Dhabi Health Services (SEHA), United Arab Emirates.
  • Alin Alkwarit5Intern pharmacist, Abu Dhabi, United Arab Emirates.
  • Asma Faisal Alshammari6Student, College of Pharmacy, University of Hail (UOH), Hail, Kingdom Saudi Arabia (KSA).
  • Israa Yousif EL Khidir7Assistant Professor, Clinical Pharmacist, University of Najran, Najran, Kingdom Saudi Arabia (KSA).
  • Nouf Eid Alrashidi8Student, College of Pharmacy, University of Hail (UOH), Hail, Kingdom Saudi Arabia (KSA).
  • Parisa kouhgard9College of Pharmacy, Al Ain University, Abu Dhabi Campus, Sheikh Khalifa Medical City Intern, Abu Dhabi, United Arab Emirates.
  • Mariam Mohamed Al Qahtani10Pharmacy student, College of Pharmacy, Al Ain University, Abu Dhabi campus, United Arab Emirates.
  • Semira Abdi Beshir11Associate Professor, Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates.
  • Khalid Awad Al-Kubaisi12Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates.
  • Nadia Al Mazrouei13Department of Pharmacy Practice and Pharmacotherapeutics, Faculty of Pharmacy, University of Sharjah, United Arab Emirates.
  • Maisoun Alkaabi14General Manager, New Medical Center (NMC) Royal Women's Hospital, Abu Dhabi, United Arab Emirates.
  • Afaf Ashoor15Cardiologist, Alkuwaiti Hospital, Dubai, United Arab Emirates.

Volume 21 Issue 2 Pages 1-7

DOI: 10.18549/PharmPract.2023.2.2824

Abstract

Background: Combined hydralazine-nitrate has an avenue in the management of subjects with heart failure with reduced ejection fraction. Exploring the pharmacotherapy in this context will facilitate the clinical utility of the combined therapy. Objective: The main objective of this mini-review was to evaluate the role of combined hydralazine-nitrate in subjects with heart failure with reduced ejection fraction. Methods: We conducted a literature search on Google scholar, MEDLINE, and PubMed to identify the randomized clinical trials on combined hydralazine-nitrate, in subjects with heart failure with reduced ejection fraction. 2760 articles were returned initially out of which 10 trials were conforming to the inclusion criteria. However, three trails were the focus for the current mini-review. Key findings: The current mini-review lends support to the use of combined hydralazine-nitrate in subjects with heart failure with reduced ejection fraction (HFrEF). The combination may offer subjects who have remained symptomatic with HFrEF despite optimum dosing of standard therapy. Black subjects with HFrEF have proved to benefit from combined hydralazine-nitrate. The combination (e.g. small dose of hydralazine 12.5-25 mg twice a day and isosorbide mononitrate 10 mg twice a day) may provide alternative clinical utility in subjects with contraindications (renal artery stenosis, creatinine clearance less than 30 mL/minute, sustained hyperkalemia) to the use of ACEinh, ARBs, and/or ARNI. Subjects with HFrEF on combined hydralazine-nitrate should be assessed and monitored for systolic BP (keep >120 mmHg) and subjects with chronic kidney disease (keep eGFR > 30 mL/min/1.73 m2). Hydralazine-nitrate was inferior to ACEinh (higher all-cause mortality and cardiovascular mortality). Conclusion: The current mini-review provides the key points to support the use of hydralazine-nitrate in subjects with heart failure with reduced ejection fraction.

Keywords

  • hydralazine-nitrate
  • heart failure with reduced ejection fraction (HFrEF)
  • hydralazine
  • isosorbide dinitarte
  • randomized clinical trials
  • Vasodilator Heart Failure Trial I (V-HeFT I)
  • the Vasodilator Heart Failure Trial II (V-HeFT II)
  • New York Heart Association (NYHA)
Pharmacy Practice

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