If ACE inhibitors are contraindicated because of angioedema, hypotension, poor renal function, renal artery stenosis or hypokalemia, consider hydralazine and nitrate combinations. Nitrates alone administered by the oral or transdermal routes are effective in reducing symptoms of pulmonary vascular congestion such as orthopnea and paroxysmal nocturnal dyspnea.

Nitrates and hydralazine both improve survival and improve quality of life in patients with CHF and LVEFs < 0.40. Nitrates and hydralazine may be used in conjunction with ACE inhibitors in patients whose CHF is not responding satisfactorily to sodium restriction, diuretics, ACE inhibitors and digoxin.

Commonly Used Drugs in the Management of CHF