- R H Strasser: Innere Medizin III/Kardiologie, Universität Heidelberg.
For nitrates their efficacy in acute and chronic heart failure has to be differentiated. In acute heart failure the hemodynamic and symptomatic improvements after administration of short term nitrate therapy render this form of therapy a standard medication. In contrast, the therapy with nitrates in chronic heart failure has not significantly improved prognosis especially when compared with ACE-inhibitors. On the contrary, nitrates in chronic heart failure tend to increase the sympathetic tone which is negatively correlated to survival. Thus, nitrates are only adjunctive therapy in patients with chronic heart failure.