From the Guidelines
Hydralazine is used for treating hypertension and heart failure, typically starting at 10-25 mg orally three to four times daily for hypertension, with doses gradually increased to 50-100 mg four times daily if needed. For heart failure, hydralazine is often combined with isosorbide dinitrate, with typical doses of 37.5-75 mg hydralazine three times daily, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. Hydralazine works by directly relaxing vascular smooth muscle, causing vasodilation primarily in arteries and arterioles, which reduces peripheral resistance and lowers blood pressure. Common side effects include headache, palpitations, tachycardia, and fluid retention. Long-term use requires monitoring for drug-induced lupus-like syndrome, particularly in slow acetylators. In the context of heart failure with reduced ejection fraction (HFrEF), the combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV HFrEF on guideline-directed medical therapy, as stated in the 2013 ACCF/AHA guideline for the management of heart failure 1. Additionally, the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults provides guidance on the use of hydralazine in hypertensive emergencies, with an initial dose of 10 mg via slow IV infusion, repeated every 4–6 h as needed 1. It is essential to note that Hidrasec (racecadotril) is an antidiarrheal medication and is not used for cardiovascular conditions, and therefore, should not be confused with hydralazine. Key considerations in the use of hydralazine include:
- Starting with low doses and gradually increasing as needed and tolerated
- Monitoring for side effects, particularly in vulnerable populations such as the elderly
- Combining with other medications, such as isosorbide dinitrate, for optimal management of heart failure
- Regular monitoring for drug-induced lupus-like syndrome with long-term use.
From the Research
Hidrasec (Hydralazine) for Treating Hypertension or Heart Failure
- Hidrasec, also known as Hydralazine, is a medication used to treat hypertension and heart failure.
- The proper use of Hidrasec for treating hypertension or heart failure is not directly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the use of other medications, such as chlorthalidone, hydrochlorothiazide, and zilebesiran, for treating hypertension.
- Chlorthalidone and hydrochlorothiazide are diuretics that are commonly used to treat hypertension, and their effectiveness and safety have been compared in several studies 2, 5.
- Zilebesiran is an investigational RNA interference therapeutic that has been shown to reduce serum angiotensinogen levels and systolic blood pressure in patients with hypertension 6.
- The use of diuretics, such as chlorthalidone and hydrochlorothiazide, may constitute a risk factor for preventable cardiovascular and renal disease progression, and the earlier prescription of MR antagonists coincident with diuretics may be necessary to gain the full benefits of diuretic therapy in treatment-resistant hypertension 3.
- Hydrochlorothiazide has been shown to reduce cardiac hypertrophy, fibrosis, and Rho-kinase activation in a preclinical model of hypertension 4.
Key Findings
- Chlorthalidone may be associated with reduced major adverse cardiovascular events and noncancer deaths in patients with prior myocardial infarction or stroke compared with hydrochlorothiazide 2.
- Chlorthalidone was associated with a significantly higher risk of hypokalemia, hyponatremia, acute renal failure, chronic kidney disease, and type 2 diabetes mellitus compared with hydrochlorothiazide 5.
- Zilebesiran resulted in significant systolic blood pressure reductions compared with placebo at 3 months in patients with uncontrolled hypertension despite treatment with indapamide, amlodipine, or olmesartan 6.