Alternative vasodilator therapy for HFrEF
The combination of high doses of the arterial vasodilator hydralazine and the venodilator isosorbide dinitrate has been reported to improve outcomes in patients with HFrEFCohn, 1986Taylor, 2004. For patients who cannot tolerate a renin-angiotensin system inhibitor, this therapy could be used in combination with other standard therapy (ie beta blocker, mineralocorticoid receptor antagonist and sodium-glucose co-transporter 2 inhibitor). Use:
hydralazine 50 to 75 mg orally, 8-hourly hydralazine hydralazine hydralazine
PLUS EITHER
1isosorbide dinitrate 20 to 40 mg orally, 8-hourly isosorbide dinitrate isosorbide dinitrate isosorbide dinitrate
OR
1isosorbide mononitrate 60 to 120 mg orally, daily. isosorbide mononitrate isosorbide mononitrate isosorbide mononitrate