{"id":"a83c3577cfd2","type":"article","url":"https://hartvaat.nl/2025/03/01/kaliumnitraat-bij-hfpef-gerandomiseerde-trial/","title":"Kaliumnitraat bij HFpEF: gerandomiseerde trial","title_en":"Potassium Nitrate in Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4417","source_url":"https://doi.org/10.1001/jamacardio.2024.4417","authors":["Payman Zamani","Sanjiv J Shah","Jordana B Cohen","Manyun Zhao","Wei Yang","Jessica L Afable","Maria Caturla","Hannah Maynard","Bianca Pourmussa","Cassandra Demastus","Ipsita Mohanty","Michelle Menon Miyake","Srinath Adusumalli","Kenneth B Margulies","Stuart B Prenner","David C Poole","Neil Wilson","Ravinder Reddy","Raymond R Townsend","Harry Ischiropoulos","Thomas P Cappola","Julio A Chirinos"],"significance":6,"published":"2025-03-01","source_date":"2025-03-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial of potassium nitrate in HFpEF tested whether inorganic nitrate supplementation improves exercise tolerance through enhanced nitric oxide availability, exploring a dietary approach to the NO-deficiency hypothesis.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht anorganisch nitraat bij HFpEF om de NO-beschikbaarheid te verbeteren. Het middel verbeterde de inspanningscapaciteit niet significant, wat nitraattherapie bij HFpEF onwerkzaam maakt.","abstract_original":"IMPORTANCE: Nitric oxide deficiency may contribute to exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). Prior pilot studies have shown improvements in exercise tolerance with single-dose and short-term inorganic nitrate administration. OBJECTIVE: To assess the impact of chronic inorganic nitrate administration on exercise tolerance in a larger trial of participants with HFpEF. DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized double-blinded crossover trial was conducted at the University of Pennsylvania, the Philadelphia Veterans Affairs Medical Center, and Northwestern University between October 2016 and July 2022. Participants included patients with symptomatic (New York Heart Association class II/III) HFpEF who had objective signs of elevated left ventricular filling pressures. Image quantification, physiological data modeling and biochemical measurements, unblinding, and statistical analyses were completed in 2024. INTERVENTION: Potassium nitrate (KNO3) (6 mmol 3 times daily) vs equimolar doses of potassium chloride (KCl) for 6 weeks, each with a 1-week washout in between. MAIN OUTCOMES AND MEASURES: The coprimary end points included peak oxygen uptake and total work performed during a maximal effort incremental cardiopulmonary exercise test. Secondary end points included the exercise systemic vasodilatory reserve (ie, reduction in systemic vascular resistance with exercise) and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire. RESULTS: Eighty-four participants were enrolled. Median age was 68 years and 58 participants were women (69.0%). Most participants had NYHA class II disease (69%) with a mean 6-minute walk distance of 335.5 (SD, 97.3) m. Seventy-seven participants received the KNO3 intervention and 74 received the KCl intervention. KNO3 increased trough levels of serum nitric oxide metabolites after 6 weeks (KNO3, 418.4 [SD, 26.9] uM vs KCl, 40.1 [SD, 28.3] uM; P < .001). KNO3 did not improve peak oxygen uptake (KNO3, 10.23 [SD, 0.43] mL/min/kg vs KCl, 10.17 [SD, 0.43] mL/min/kg; P = .73) or total work performed (KNO3, 25.9 [SD, 3.65] kilojoules vs KCl, 23.63 [SD, 3.63] kilojoules; P = .29). KNO3 nitrate did not improve the vasodilatory reserve or quality of life, though it was well-tolerated. CONCLUSIONS AND RELEVANCE: In this study, potassium nitrate did not improve aerobic capacity, total work, or quality of life in participants with HFpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02840799."}