How Nitrates Treat Systolic Heart Failure

Topic Overview

Nitrates are medicines that act as vasodilators because they mimic the effect of one of the body's own natural chemicals called nitric oxide, which causes arteries and veins to widen (dilate).

Nitrates can improve heart failure symptoms by:

  • Dilating the coronary arteries. These are the arteries that carry blood to the heart itself. If your heart failure is caused by coronary artery disease, increasing the width of these arteries may help deliver more blood to your heart and may help it pump more efficiently.
  • Dilating the veins. The large veins of the body, particularly in the legs, have the ability to hold a lot of blood. By dilating these veins, nitrates reduce the amount of blood returning to the heart, thereby reducing the buildup of fluid in your lungs.
  • Dilating the systemic arteries. Systemic arteries are blood vessels that carry blood to the rest of the body (excluding the heart and lungs). The blood pressure in these arteries determines how hard your heart needs to pump. By dilating these arteries, nitrates may relieve some of the work your heart needs to do.
  • Dilating the pulmonary arteries.Dilating the arteries of the lungs (pulmonary arteries) also reduces the amount of work your heart needs to do. This effect is particularly helpful for the right side of your heart, which is often weakened along with the left side of the heart in some forms of heart failure.

How well do nitrates work?If you take a nitrate, you will likely also take other medicines such as diuretics, ACE inhibitors, and beta-blockers. Nitrates may be prescribed with another vasodilator, hydralazine, for heart failure. This combination of medicines may help relieve symptoms and lower the risk of early death. This benefit has been shown in African Americans but has not been shown in other groups of people.1 Hydralazine and a nitrate may be taken by people who cannot tolerate an ACE inhibitor.

Nitrates are also a good choice for people with heart failure who also have coronary artery disease, because these agents can dilate the coronary arteries and relieve angina.

Related Information



  1. Hunt SA, et al. (2009). 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 119(14): e391–e479.


Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Editor Marianne Flagg
Associate Editor Terrina Vail
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Last Updated August 25, 2008

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