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Related Experiment Videos

Nitrate tolerance and dependence. A critical assessment.

J Abrams

    La Nouvelle Presse Medicale
    |September 25, 1980
    PubMed
    Summary

    Nitrate tolerance is a known phenomenon, but its clinical significance in treating heart failure and angina remains uncertain. While some studies show tolerance, current evidence suggests it

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    Area of Science:

    • Cardiovascular Pharmacology
    • Clinical Therapeutics

    Background:

    • Nitrate tolerance and cross-tolerance have been recognized since the early 1900s.
    • Long-acting nitrates are crucial in managing congestive heart failure and angina.
    • High-dose nitrate regimens necessitate understanding potential tolerance development.

    Purpose of the Study:

    • To evaluate the clinical significance of nitrate tolerance in cardiovascular therapy.
    • To assess the impact of high-dose nitrate regimens on treatment efficacy.

    Main Methods:

    • Review of older studies documenting tolerance to hemodynamic and headache responses.
    • Analysis of animal experiments confirming nitrate tachyphylaxis.
    • Examination of recent investigations using high-dose isosorbide dinitrate (ISD) in angina and heart failure patients.

    Main Results:

    • Older studies and animal models confirm rapid nitrate tolerance (tachyphylaxis).
    • Recent studies with high-dose ISD have largely failed to demonstrate significant anti-anginal or hemodynamic tolerance.
    • Emerging evidence suggests tolerance to high-dose ISD may occur in angina patients, potentially reducing efficacy.

    Conclusions:

    • Clinically relevant nitrate tolerance appears to be rare in the treatment of cardiac diseases.
    • While attenuated vasodilator responses may occur with prolonged therapy, tolerance is not considered a major impediment.
    • Further research is needed to fully elucidate the nuances of nitrate tolerance in diverse patient populations.

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