How effective is Imdur (Isosorbide Mononitrate) in treating hypertension?

From the Guidelines

Imdur is not a recommended treatment for high blood pressure, and its use for this purpose is not supported by current guidelines. Imdur (isosorbide mononitrate) is primarily used to prevent angina (chest pain) in patients with coronary artery disease, and while it does have some blood pressure-lowering effects, it is not considered a first-line or standard treatment for hypertension 1. According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension, ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics are recommended as first-line treatments to lower blood pressure due to their demonstrated effectiveness in reducing BP and CVD events 1.

Some key points to consider when treating hypertension include:

• The use of combination BP-lowering treatment is recommended for most patients with confirmed hypertension as initial therapy, with preferred combinations including a RAS blocker with a dihydropyridine CCB or diuretic 1.
• Fixed-dose single-pill combination treatment is recommended for patients receiving combination BP-lowering treatment 1.
• If BP is not controlled with a two-drug combination, increasing to a three-drug combination is recommended, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic, and preferably in a single-pill combination 1.

In contrast, Imdur works by relaxing blood vessels, which can temporarily reduce blood pressure, but this effect is often short-lived due to the development of tolerance with continued use. The medication is typically taken once daily in extended-release form, with common doses ranging from 30-120 mg. If someone is seeking treatment specifically for high blood pressure, other medication classes such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics would be more appropriate and effective, as they provide more consistent blood pressure control and have been extensively studied for hypertension management 1. Anyone with blood pressure concerns should consult their healthcare provider for proper evaluation and treatment recommendations tailored to their specific situation.

From the FDA Drug Label

WARNINGS Amplification of the vasodilatory effects of isosorbide mononitrate by sildenafil can result in severe hypotension. The benefits of ISMN in patients with acute myocardial infarction or congestive heart failure have not been established; because the effects of isosorbide mononitrate are difficult to terminate rapidly, this drug is not recommended in these settings. If isosorbide mononitrate is used in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia.

The drug Imdur (isosorbide mononitrate) is not primarily used to treat blood pressure. It is used to prevent angina attacks.

• The label mentions hypotension as a potential side effect, indicating that it can lower blood pressure, but it does not provide information on its effectiveness in treating high blood pressure.
• The label also states that the benefits of ISMN in patients with congestive heart failure have not been established, which suggests that it is not recommended for use in conditions where blood pressure management is critical 2.

From the Research

Imdur and Blood Pressure Treatment

• Imdur, also known as isosorbide mononitrate, is a medication used to treat angina pectoris, but its effectiveness in treating blood pressure is not directly addressed in the provided studies.
• However, studies have investigated the effects of isosorbide dinitrate, a related medication, in combination with hydralazine on blood pressure and heart failure outcomes 3, 4.
• The African-American Heart Failure Trial found that the fixed-dose combination of isosorbide dinitrate and hydralazine reduced mortality and morbidity in patients with heart failure, regardless of baseline blood pressure 3, 4.
• Another study compared the effectiveness of felodipine, a calcium channel blocker, and isosorbide mononitrate in elderly patients with angina pectoris, and found that felodipine was more effective in reducing ischemic parameters during exercise 5.
• A study on the effectiveness and safety of beta-blockers, calcium channel blockers, and angiotensin receptor blockers in hypertensive patients found that all three classes of medications had similar efficacy in reducing systolic blood pressure, but calcium channel blockers were superior to the other two medications 6.
• A study on the control of systolic hypertension found that calcium-blocking drugs and diuretics were more effective in lowering systolic blood pressure in elderly patients than beta-blockers or ACE inhibitors 7.

Key Findings

• Calcium channel blockers, such as felodipine, may be more effective in reducing blood pressure and ischemic parameters than isosorbide mononitrate or beta-blockers 5, 7.
• The fixed-dose combination of isosorbide dinitrate and hydralazine may be effective in reducing mortality and morbidity in patients with heart failure, regardless of baseline blood pressure 3, 4.
• Beta-blockers may not be as effective in lowering systolic blood pressure as calcium channel blockers or diuretics, especially in elderly patients 7.