Which class of drugs should be considered in patients who cannot tolerate ACE inhibitors or ARBs?

Hydralazine and oral nitrates are important options for patients who cannot tolerate ACE inhibitors or angiotensin receptor blockers (ARBs) due to side effects such as persistent cough or angioedema. This combination acts as a vasodilator and can help lower blood pressure while reducing the workload on the heart. Particularly in cases of heart failure, hydralazine works by dilating blood vessels, which can improve cardiac output and decrease symptoms related to fluid overload.

While beta blockers can be beneficial in managing heart failure, they are typically not the first choice for those who cannot tolerate ACE inhibitors or ARBs. Additionally, calcium channel blockers are generally not recommended for heart failure with reduced ejection fraction as they may not provide the same benefits and can potentially worsen heart failure symptoms. Diuretics are essential for managing fluid retention but do not address the underlying mechanisms of heart failure directly like the vasodilatory effects of hydralazine and nitrates do.

In summary, for patients who experience adverse effects from ACE inhibitors or ARBs, hydralazine combined with oral nitrates offers a viable alternative for managing heart failure symptoms effectively.