Hydralazine produces direct arteriolar vasodilation but consistently causes reflex tachycardia and salt retention. To counter these, it is typically combined with which pair of drugs for heart failure management?
- A Isosorbide dinitrate and a beta-blocker ✓
- B An ACE inhibitor and a loop diuretic
- C A beta-blocker and spironolactone
- D Isosorbide dinitrate and a diuretic
Correct answer: A. Isosorbide dinitrate and a beta-blocker
Explanation
The hydralazine-isosorbide dinitrate (ISDN) combination is a proven heart failure regimen especially in patients intolerant to ACE inhibitors (e.g., Black patients per A-HeFT trial). Hydralazine reduces afterload via arteriolar dilation while ISDN provides venous vasodilation reducing preload; a beta-blocker counteracts reflex tachycardia from hydralazine. This combined vasodilator strategy reduces mortality in HFrEF when ACE inhibitors/ARBs are not tolerated. The fixed-dose combination BiDil (hydralazine + ISDN) is approved for this indication.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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