ACE inhibitors and ARBs are harmful in an acute renal insufficiency case because they can increase the serum creatinine. In such a situation, hydralazine with isosorbide dinitrate may be used. Exogenous nitrate therapy has beneficial effects for HF treatment at the cellular and hemodynamic level by enhancing endothelium dependent vasodilation, improving systolic function and exercise capacity, and inhibiting cardiac remodeling black and non-black HF patients. Both Vasodilator-Heart Failure Trials I and II showed improved ejection fraction and exercise tolerance with this therapy in whites and in blacks.
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