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[Prolonged action nitrates in stable angina pectoris].

J Erikssen1, W Eidsaunet, E Thaulow

  • 1Medisinsk avdeling, Sentralsykehuset i Akershus, Nordbyhagen.

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|February 20, 1991
PubMed
Summary

Transdermal nitroglycerin and isosorbide dinitrate tablets showed similar effects and side effects in men with stable angina pectoris. Nitrate tolerance occurred in about a quarter of patients, unaffected by dosing intervals.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Stable angina pectoris management often involves long-acting nitrates.
  • Transdermal nitroglycerin and isosorbide dinitrate are common therapeutic options.

Purpose of the Study:

  • To compare the efficacy and side effect profiles of transdermal nitroglycerin and isosorbide dinitrate tablets in men with stable angina pectoris.
  • To investigate the phenomenon of nitrate tolerance and its potential prevention.

Main Methods:

  • A randomized, double-blind study involving 100 men with stable angina pectoris.
  • Comparison of subjective (angina attacks, nitroglycerin consumption) and objective (exercise ECG) measures.
  • Assessment of side effect patterns and nitrate tolerance with specific dosing intervals.

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Main Results:

  • Both transdermal nitroglycerin and isosorbide dinitrate demonstrated virtually identical subjective and objective effects.
  • Similar side effect profiles were observed for both nitrate formulations.
  • Nitrate tolerance, characterized by a lack of both subjective and objective effects, was noted in approximately 25% of patients.
  • Neither a 12-hour dosing interval for isosorbide dinitrate nor a 6-hour transdermal nitroglycerin-free interval prevented nitrate tolerance.

Conclusions:

  • Transdermal nitroglycerin and isosorbide dinitrate are comparable in treating stable angina pectoris.
  • Nitrate tolerance is a significant issue in a substantial portion of patients and is not circumvented by standard dosing adjustments.
  • The discrepancy between subjective patient experience and objective stress test results suggests potentially different underlying mechanisms for nitrate effects in daily life versus during exercise testing.