Inorganic Nitrite to Amplify the Benefits and Tolerability of Exercise Training in Heart Failure With Preserved Ejection Fraction (HFpEF) (INABLE-Training)

Inclusion Criteria

• •Age ≥ 40 years
• •Symptoms of dyspnea (II-IV) without evidence of a non-cardiac or ischemic explanation for dyspnea
• •Ejection Fraction (EF) of \> or = 50% determined on most recent imaging study within the preceding 5 years, with no change in clinical status suggesting potential for deterioration in systolic function
• •One of the following:
• •* Previous hospitalization for Heart Failure (HF) with radiographic evidence (pulmonary venous hypertension, vascular congestion, interstitial edema, pleural effusion) of pulmonary congestion or
• •* Catheterization documented elevated filling pressures at rest (Pulmonary Capillary Wedge Pressure (PCWP)= ≥15 or Left Ventricular End-Diastolic Pressure (LVEDP) ≥18) or with exercise (PCWP ≥25) or
• •* Elevated Natruretic Peptide-proBNP (\>400 pg/ml) or B-Type Natriuretic Peptide (BNP)(\>200 pg/ml) or
• •* Echo evidence of diastolic dysfunction/elevated filling pressures manifest by medial E/e' ratio≥15 and/or left atrial enlargement and chronic treatment with a diuretic for signs or symptoms of heart failure
• •Heart failure is primary factor limiting activity as indicated by answering # 2 to the following question:
• •My ability to be active is most limited by:
• •1. Joint, foot, leg, hip or back pain
• •2. Shortness of breath and/or fatigue and/or chest pain
• •3. Unsteadiness or dizziness
• •4. Lifestyle, weather, or I just don't like to be active
• •* No chronic nitrate therapy or not using intermittent sublingual nitroglycerin (requirement for \>1 sublingual nitroglycerin per week).
• •* No daily use of phosphodiesterase 5 (PDE5) inhibitors or soluble guanylyl cyclase activators and willing to withhold as needed use of PDE5 inhibitors for duration of study
• •* Ambulatory (not wheelchair / scooter dependent)
• •* Body size allows wearing of the accelerometer belt as confirmed by ability to comfortably fasten the test belt provided for the screening process.
• •* Willingness to wear the accelerometer belt for the duration of the trial