PMID: 2113003Jan 1, 1990Paper

Nitrates: why and how should they be used today? Current status of the clinical usefulness of nitroglycerin, isosorbide dinitrate and isosorbide-5-mononitrate

European Journal of Clinical Pharmacology
S Silber

Abstract

Nitrates are highly effective both in terminating acute attacks of angina pectoris and in the prophylaxis of symptomatic and asymptomatic myocardial ischemia. Preload reduction by venodilatation is the prevailing mechanism of nitrates in patients with chronic stable angina and is the unique feature distinguishing them from beta and calcium-channel blockers. Nitrates dilate coronary arteries not only in pre- and poststenotic vessels, but also in eccentric lesions. In patients with endothelial dysfunction, nitrates seem to be the physiological substitute for endothelium-derived relaxing factor. During the past decade, however, there has been substantial evidence of a clinically relevant loss of the anti-ischemic effects ("nitrate tolerance"). Many studies with oral dosing of isosorbide dinitrate or isosorbide-5-mononitrate at least three times daily have proven nitrate tolerance in patients with coronary artery disease and/or congestive heart failure. Complete loss of anti-ischemic effects after repetitive, continuous patch attachments has also been found. As we first showed in 1983, intermittent therapy with once-daily ingestion of high-dose sustained-release isosorbide dinitrate was successful in preventing the development of t...Continue Reading

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Citations

Sep 1, 1996·Journal of Cardiovascular Pharmacology·B P BoothH L Fung
Feb 28, 2008·Journal of Computer Assisted Tomography·Eun Ju ChunJae Hyung Park
Jul 26, 2019·The Journal of Physiology·Wilfried Gyselaers, Basky Thilaganathan
Apr 1, 1995·British Journal of Pharmacology·H BohnK Schönafinger
Apr 1, 2008·Journal of Cardiovascular Pharmacology and Therapeutics·Diane L Guettler, Sheng-Xing Ma
Nov 1, 1992·Postgraduate Medical Journal·S R Maxwell, M J Kendall
Jun 12, 2010·Cardiology in Review·Vaughn E NossamanPhilip J Kadowitz
Aug 5, 2016·The Cochrane Database of Systematic Reviews·Na ZhaoYuguang Huang

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