Study of Organic Nitrates in CHF Patients Taking 
ACE Inhibitors

	Organic nitrates are widely used in CHF 
treatment but no information is available about
their effect in patients already taking ACE 
inhibitors.
	We studied the effects of high-dose (50
to 100 mg) transdermal nitroglycerin vs placebo
given for 12 hours daily in 29 CHF patients - 
heart class 2-3. Exercise time (4 hours after patch
application) showed progressive improvement during
nitro administration, with an increase of 38 
seconds at the end of the first month, 76 seconds
at the end of the second month, and 117 seconds at
the end of the third month. No significant change
was seen for placebo.
	Scores for quality of life and need for
additional diuretics or hospitalizations did not 
show a significant difference between the 2 
treatment periods. However, nitroglycerin use
decreased heart size and improved fractional
shortening. Placebo had no effect on these
measurements.

	Conclusion: High-dose nitrate therapy 
improves exercise tolerance and left ventricular 
size and function in patients with mild to moderate
CHF, who are already taking ACE inhibitors. This
supports the use of organic nitrates as additional
therapy to ACE inhibitors in patients with chronic
CHF. 

Title: Double-Blind, Placebo-Controlled Study to 
Evaluate the Effect of Organic Nitrates in Patients
With Chronic Heart Failure Treated With Angiotensin
-Converting Enzyme Inhibition

Authors: Uri Elkayam MD, Janet Johnson RN BSN, 
Avraham Shotan MD, Syed Bokhari MD, Alejandro 
Solodky MD, Menahem Canetti MD, Omar Rashid Wani MD,
Ilyas Somer Karaalp MD

From the Heart Failure Program, Division of 
Cardiology, Department of Medicine, University of
Southern California School of Medicine