Long-Acting Nitrates No Good for Heart Failure with Preserved Ejection Fraction


Am Fam Physician. 2016 May 1;93(9):790.

Clinical Question

Should nitrates be prescribed for patients who have heart failure with preserved ejection fraction?

Bottom Line

Patients who have heart failure with preserved ejection fraction had decreased levels of activity and more adverse events when they were receiving isosorbide mononitrate than when they were taking a placebo. Moreover, activity levels decreased with increases in the dose of the drug, suggesting a strong correlation. However, almost 90% of the patients in this study were white, which may limit its generalizability. (Level of Evidence = 1b)


Previous studies note that up to 50% of patients who have heart failure with preserved ejection fraction receive nitrates, but the effectiveness of this therapy has not been extensively studied in this population. In the current trial, investigators enrolled patients with a diagnosis

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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Apr 15, 2017

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