AHA: Long-Acting Nitrate Flops in HFpEF

Does this stuff create nitric oxide? If yes, who the hell is going to run a clinical trial on stroke survivors for all the benefits of nitric oxide? ANYONE AT ALL? Or are we screwed once again because we have no leaders running a stroke strategy?
http://www.medpagetoday.com/MeetingCoverage/AHA/54550?xid=nl_mpt_DHE_2015-11-09&eun=g424561d0r
Heart failure patients with preserved ejection fraction not only do not improve their exercise tolerance if treated with isosorbide mononitrate, they do worse.
Nitrate treatment did not improve levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) or increase distance on a 6-minute walk, according to Margaret M. Redfield, MD, of the Mayo Clinic, who reported the findings from the Nitrate's Effect on Activity Tolerance in Heart Failure with Preserved Ejection Fraction (NEAT-HFpEF) as a late-breaking clinical trial at the American Heart Association meeting here.

Advertisement

At every tested nitrate dose, patients had lower levels of activity than patients taking placebo, Redfield said.
"With increasing nitrate doses activity decreased significantly," she said. Also more patients taking nitrates had worsening heart failure and worsening syncope.
Redfield said it was difficult to estimate the exact level of nitrate use in HFpEF patients, but published studies suggest that the drugs are used in 15% to 50% of patients. "My assessment, however, is that this study provides a very strong signal that nitrates have no benefit and may have promote adverse events in patients," she said.
Mariell Jessup, MD, medical director of the Penn Heart and Vascular Center in Philadelphia, agreed that it was very difficult to assess nitrate use, and she suggested that when it was used, it reflected the desperation of clinicians seeking "something that works." But the findings from NEAT would clarify the issue for herself and others treating HFpEF. Jessup, who is a former AHA president, moderated a press briefing where the NEAT results were discussed.
Redfield added that inorganic nitrite or nitrate might have been a better choice for the study drug because either could increase "nitric oxide bioavailability during exercise."
ACC Video Conference Reporter: Watch our exclusive snippets of study authors and discussants from AHA 2015