[Nitrates in therapy of effort angina in hypotensive patients]

A randomized single blind cross-over trial with placebo lead-in has been conducted in 71 anginal patients with arterial hypotension (group 1) and 38 ischemic heart disease patients with normal arterial pressure (group 2) to compare efficacy of therapy with isosorbide dinitrate (ID), sustac-forte (SF), isosorbide dinitrate retard (IDR) and trinitrolong (TN). Paired bicycle exercises revealed that in group 1 patients ID was low effective in 49%, SF--in 61%, IDR was highly effective in 97% and TN--in 96%. In group 1 tolerance to antianginal effect of ID, SF and IDR shown by stress myocardial scintigraphy with Tl-199 developed earlier--in 2-4 weeks in 63-70% patients (versus 22-27% in group 2; p < 0.01). Recovery of ID, SF, IDR effect required prolongation of the drug withdrawal period to 8-16 days (versus 3-5 days in group 2; p < 0.05). TN therapy remained effective for 3 months. Resistance to ID, SF in group 1 was relative and depended on dosage form of nitrates.