Related Experiment Videos
[How nitrate tolerance be prevented in the treatment of ischemic heart disease?]
1Kliniki Choroby Wieńcowej Instytutu Kardiologii w Warszawie.
Abstract:
Organic nitrates are widely used for chronic treatment of ischaemic heart disease. However, the clinical value of long-term nitrate therapy is limited by the development of tolerance to their anti-anginal effects. This paper examines the different effects of nitrates, especially cellular effects. The theories put forward to explain nitrate tolerance are examined, including recent work on vascular superoxide and endothelin-1 regulation. Clinically, tolerance can be prevented by intermitted dosing of nitrates. This topic, and the practical results of work using other pharmacologic interventions in a clinical setting are discussed in the final section of this article.
Insights
Organic nitrates treat ischaemic heart disease but tolerance limits their use. Intermittent dosing can prevent this tolerance, maintaining the anti-anginal effects of nitrate therapy.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Cell Biology
Context:
- Organic nitrates are a cornerstone therapy for chronic ischaemic heart disease.
- Nitrate tolerance significantly diminishes the long-term clinical efficacy of these anti-anginal agents.
Purpose:
- To review the cellular mechanisms underlying nitrate tolerance.
- To explore theories explaining tolerance, including oxidative stress and endothelin-1.
- To discuss clinical strategies for preventing tolerance, such as intermittent dosing.
Summary:
- This paper investigates the cellular effects of organic nitrates and the mechanisms contributing to tolerance.
- It examines current theories on nitrate tolerance, focusing on vascular superoxide and endothelin-1.
- The review highlights intermittent nitrate dosing as a clinical strategy to overcome tolerance.
Impact:
- Provides insights into the cellular basis of nitrate tolerance.
- Informs clinical practice regarding optimizing long-term nitrate therapy for ischaemic heart disease.
- Suggests practical interventions to maintain the therapeutic benefits of nitrates.