[Continuing anti-anginal effectiveness during chronic nitrate therapy in spite of the cessation of hemodynamic...

A decrease or actual cessation of some of the haemodynamic effects of nitrate, such as fall in blood pressure and rise in heart rate on standing upright, was observed in ten patients with coronary heart disease during a four-week period of treatment with nonretard isosorbide dinitrate, 20 and 40 mg six times daily. Disappearance of the nitrate effect was also observed by ultrasound over arterial and central venous vessels. At the same time, a crossover double-blind randomized study demonstrated that the anti-anginal action persisted. This effect is thus to be taken as preventing anginal attacks. It is concluded that chronic nitrate administration maintains its full anti-anginal action, even though haemodynamic effects are diminished or even cease completely.