Isosorbide Dinitrate Mechanism and Clinical Use
Mechanism of Action
- Isosorbide dinitrate functions as a potent venodilator with secondary effects on arterial tone, acting through the cyclic guanosine monophosphate pathway 1, 2, 3
Clinical Context and Efficacy
- The American Heart Association recommends isosorbide dinitrate in combination with hydralazine for heart failure management, providing complementary vasodilation and mortality reduction in heart failure patients, particularly in Black patients 4, 6
- Isosorbide dinitrate can cause tachycardia as a hazard, particularly in acute settings, due to vasodilation-induced hypotension triggering sympathetic activation 4
- The combination of isosorbide dinitrate and hydralazine does not target heart rate as a therapeutic endpoint, and beta-blockers or other rate-controlling agents should be used instead for heart rate control in cardiovascular disease 3, 4