Nitroso-redox balance in the cardiovascular system.

The results with the combination therapy were markedly positive, meeting the composite end point of the trial, which included death from any cause, a first hospitalization for heart failure, and quality-oflife measures. In addition, there was an impressive reduction in the rate of death from any cause of approximately 45 percent, leading to an early termination of the study. This trial raises fascinating issues regarding heart-failure therapeutics and variations in drug susceptibility among populations. Attempting to understand these issues requires insight into the pharmacologic and biologic underpinnings of any drug combination that may enhance nitric oxide availability. This regimen of isosorbide dinitrate and hydralazine (which are available individually as inexpensive, generic formulations), initially selected for its vasodilatory properties in the Veterans Administration Heart Failure Trials (V-Heft) I and II, 2