Combined effects of calcium antagonists and nitroglycerin on large coronary artery diameter

Nitroglycerin and calcium antagonists are direct dilators of large coronary arteries. Their amelioration of myocardial ischemia may be in part related to their dilating action on coronary stenoses. The present study was done to determine if the effects of calcium antagonists and nitroglycerin on large coronary arterial diameter are additive. External circumflex coronary arterial diameter was measured by sonomicrometry in 16 awake, instrumented dogs. Intravenous nifedipine (mean dose 30 +/- 4 micrograms/kg) caused dilation of the circumflex coronary artery (4.01 +/- 0.13 to 4.10 +/- 0.12 mm, p less than 0.05). The addition of intravenous nitroglycerin (10 to 20 micrograms/kg) caused further coronary arterial dilation (4.10 +/- 0.12 to 4.13 +/- 0.12 mm, p less than 0.05). Intravenous verapamil (mean dose 520 +/- 77 micrograms/kg) also caused dilation of the circumflex coronary artery (4.14 +/- 0.35 to 4.26 +/- 0.35 mm, p less than 0.05). The addition of intravenous nitroglycerin caused further dilation (4.26 +/- 0.35 to 4.31 +/- 0.35 mm, p less than 0.05). Intravenous diltiazem (mean dose 640 +/- 140 micrograms/kg) caused circumflex coronary arterial dilation in four of the five dogs studied (mean change 4.14 +/- 0.36 to 4.21 +/- 0.33 mm). The addition of intravenous nitroglycerin caused further circumflex coronary dilation (4.21 +/- 0.33 to 4.26 +/- 0.33 mm, p less than 0.05). Therefore, the effects of nitroglycerin and each of these three calcium antagonists on large coronary diameter are additive, with the combination of nitroglycerin and the calcium antagonist causing more large coronary dilation than the calcium antagonist alone.