We recommend the combination of isosorbide dinitrate and hydralazine be considered in addition to standard therapy for Black Canadians with HF-REF (Strong Recommendation, Quality Moderate) and may be considered for others including non-black HF patients unable to tolerate an ACEi or ARB because of intolerance, hyperkalemia or renal dysfunction. (Recommendation Strong, Quality Low).

Values and Preferences Adverse effects such as headache, nausea, dizziness and hypotension are common and frequently require a reduction in dose or discontinuation.