Acute drug testing with nitrates: angina relief during treadmill exercise

Area of Science:

• Cardiology
• Pharmacology

Background:

• Angina pectoris management often involves nitrates.
• Sublingual nitroglycerin (N) and chewable isosorbide dinitrate (I) are common treatments.
• Individual patient response to nitrates can vary.

Purpose of the Study:

• To compare the efficacy of sublingual nitroglycerin (N) and chewable isosorbide dinitrate (I) in patients with angina pectoris.
• To determine the duration of action and effectiveness of N and I in exercise-induced angina.
• To identify patient subgroups that may benefit more from I or N therapy.

Main Methods:

• 12 patients with angina pectoris underwent treadmill exercise tests.
• Nitroglycerin (N), isosorbide dinitrate (I), or placebo (P) was administered at angina onset.
• Exercise continued until angina recurrence or a maximum test time of three hours.
• Each patient was tested with N, I, and P within a two-week period.

Main Results:

• Isosorbide dinitrate (I) showed a significant angina relief and recurrence time (154' 3" +/- 4' 27") in 4 patients (P <= 0.05).
• Nitroglycerin (N) demonstrated significant effect with angina relief and recurrence time (49' 39" +/- 1' 15") in 6 patients (P <= 0.01).
• Only one patient experienced angina relief with placebo (P).

Conclusions:

• Isosorbide dinitrate (I) may offer a possible benefit in selected angina patients, with effects lasting 3-4 hours.
• Nitroglycerin (N) shows enhanced benefit in the upright position, lasting 40-50 minutes.
• Treadmill testing with nitrate administration is recommended to personalize treatment for angina pectoris.