[Is it worthwhile to treat stable angina pectoris with long-acting nitrates?]

Organic nitrates have been used in the treatment of angina pectoris for over a century. During the last twenty years, their use has also been expanded to include the treatment of unstable angina and congestive heart failure. Although nitrates are among the most often used drugs in coronary artery disease, to date, their long-term use has not been investigated in any large-scale clinical trials. The finding, recently published by Nakamura et al., that long-term nitrate use may be deleterious in ischemic heart disease, may therefore be the start of a critical re-examination of this traditional form of therapy. This paper examines the different effects of nitrates in various clinical situations. The pharmacological and physiological beneficial mechanisms of nitrates in coronary artery disease, and also the potentially harmful mechanisms are discussed in the final section of this article.