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[Afterload reduction by long-term nitrate therapy].

A Wortmann1, K Bachmann

  • 1Medizinische Klinik II mit Poliklinik der Universität Erlangen-Nürnberg.

Zeitschrift Fur Kardiologie
|January 1, 1989
PubMed
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Longterm nitrate therapy for heart failure often causes tolerance. Interval therapy with isosorbide dinitrate (ISDN) sustained afterload reduction, maintaining benefits without tolerance.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Nitrate therapy is crucial for heart failure, but tolerance to arterial and venous effects is common with frequent dosing.
  • Maintaining balanced preload and afterload is essential for effective congestive heart failure management.
  • Interval therapy, a once-daily nitrate regimen, demonstrates tolerance-free preload effects.

Purpose of the Study:

  • To investigate the efficacy of longterm interval therapy with isosorbide dinitrate (ISDN) in reducing afterload in patients with coronary heart disease.
  • To compare the acute and chronic effects of once-daily ISDN on afterload reduction.

Main Methods:

  • Nine patients with coronary heart disease (NYHA II-III) experiencing exercise-induced congestion were enrolled.
  • Patients received once-daily 120 mg ISDN sustained-release (s.r.) after a washout period.

Related Experiment Videos

  • Mean arterial pressure and cardiac output were measured to assess acute (first dose) versus chronic (5 weeks) effects on afterload.

    • Main Results:

    • Acute therapy with ISDN significantly reduced mean arterial pressure during exercise by 14%.
    • Peripheral resistance decreased by 21% after the first dose, indicating effective afterload reduction.
    • These afterload-reducing effects were maintained throughout the 5-week chronic interval therapy period.

    Conclusions:

    • Longterm interval therapy with once-daily ISDN effectively reduces afterload in patients with coronary heart disease.
    • This dosing strategy overcomes the tolerance issues associated with traditional, frequently dosed nitrate regimens.
    • Once-daily ISDN offers a promising approach for sustained afterload management in heart failure patients.