NSTK · 01.2026Independent supplement reference
NutriStack
Edition 1.0Updated July 13, 2026

Hydralazine

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026

Hydralazine is a direct arteriolar vasodilator used for hypertension and heart failure. The A-HeFT trial demonstrated significant mortality benefit when combined with isosorbide dinitrate (BiDil) in self-identified Black patients with heart failure. Also used for hypertensive emergencies in pregnancy.

Evidence tier
Strong
Indexed sources
10 2003–2025
Interactions
0
Depletes
1 nutrient
Read the sources → Compare profiles
Publication status

Exploratory record, not a reviewed medical publication.

See the editorial and medical-review policies for the publication gate.

This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.

In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Hydralazine is a direct arteriolar vasodilator used for hypertension and heart failure. NutriStack rates the supporting evidence as strong. Common adult dosing is 25–100 mg 2–3 times daily (HF combination: 37.5 mg three times daily with ISDN) (as prescribed by your physician), though a prescriber sets the actual dose. With long-term use it can deplete vitamin b6. This profile indexes 10 sources.

What it's good for
  • Reduces mortality in Black patients with HFrEF (A-HeFT, combined with ISDN)6,7
  • Direct arteriolar vasodilation reduces afterload
  • Safe in pregnancy for hypertension management1,2
  • Alternative for patients intolerant to ACE inhibitors and ARBs
What to watch for
  • Reflex tachycardia
  • Headache
  • Flushing
  • Coronary artery disease (may worsen ischemia due to reflex tachycardia, use with beta-blocker)
  • Mitral valve rheumatic heart disease4,6

The bottom line

Evidence rating strong. Most-documented uses: reduces mortality in black patients with hfref (a-heft, combined with isdn), direct arteriolar vasodilation reduces afterload, safe in pregnancy for hypertension management. 10 sources indexed (2003–2025), with 0 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Directly relaxes arteriolar smooth muscle through incompletely understood mechanisms, possibly involving interference with calcium transport, increased nitric oxide release, or activation of potassium channels. Reduces peripheral resistance without significant venous dilation. Causes reflex tachycardia and increased cardiac output. Combined with nitrates, the hydralazine-nitrate combination improves NO bioavailability by scavenging reactive oxygen species.

Class
Direct Arteriolar Vasodilator
Absorption
Water-soluble; take with food
Dosing

Dosing & protocol.

Common range
25–100 mg 2–3 times daily (HF combination: 37.5 mg three times daily with ISDN) (as prescribed by your physician)
Recommended form
Oral tablet or IV/IM injection

Food enhances bioavailability; undergoes extensive first-pass hepatic metabolism via acetylation (metabolism rate depends on acetylator phenotype)

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

Vitamin B6

Moderate

Hydralazine can antagonize pyridoxine metabolism and has been linked to pyridoxine-deficiency neuropathy during prolonged therapy.

Replace PyridoxineMonitor Clinical neuropathy assessment + plasma PLP if availableOnset Usually with high-dose or prolonged therapy
Safety

Full safety detail.

Side effects

  • Reflex tachycardia
  • Headache
  • Flushing
  • Palpitations
  • Dizziness
  • Drug-induced lupus-like syndrome (dose-related, >200 mg/day)
  • Peripheral neuropathy (pyridoxine-responsive)
  • Sodium and water retention

Contraindications

  • Coronary artery disease (may worsen ischemia due to reflex tachycardia, use with beta-blocker)
  • Mitral valve rheumatic heart disease4,6
  • Dissecting aortic aneurysm
  • SLE (may worsen)
Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Meta-analyses & systematic reviews

5

Reference material

5
FAQ

Common questions.

Quick answers about Hydralazine, drawn from the data on this page.

What is Hydralazine?

Hydralazine is a direct arteriolar vasodilator used for hypertension and heart failure. The A-HeFT trial demonstrated significant mortality benefit when combined with isosorbide dinitrate (BiDil) in self-identified Black patients with heart failure. Also used for hypertensive emergencies in pregnancy.

What is Hydralazine used for?

Commonly cited benefits of Hydralazine include: Reduces mortality in Black patients with HFrEF (A-HeFT, combined with ISDN); Direct arteriolar vasodilation reduces afterload; Safe in pregnancy for hypertension management; Alternative for patients intolerant to ACE inhibitors and ARBs. NutriStack rates the overall evidence as strong.

What is a typical dose of Hydralazine?

A typical adult dose of Hydralazine is 25–100 mg 2–3 times daily (HF combination: 37.5 mg three times daily with ISDN) (as prescribed by your physician). The commonly recommended form is Oral tablet or IV/IM injection. These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Hydralazine?

Reported side effects include reflex tachycardia, headache, flushing, palpitations, dizziness, drug-induced lupus-like syndrome (dose-related, >200 mg/day). This is educational information; check with a healthcare professional before use.

How strong is the evidence for Hydralazine?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

Use this with your stack

Hydralazine in NutriStack.

Add it to your stack, see how it interacts with everything else you take, and get a Stack Score that updates the moment it does.

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NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.