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[Treatment of severe hypertension and hypertensive crises with nitrates]
Insights
Nitrates effectively reduce blood pressure and resistance in hypertensive patients, particularly proving beneficial in hypertensive crises with cardiovascular complications. Long-term nitrate efficacy requires further investigation.
Area of Science:
- Cardiovascular Pharmacology
- Clinical Hypertension Research
Context:
- Hypertension frequently co-occurs with ischemic heart disease and heart insufficiency.
- The roles of blood pressure, preload, and afterload are critical when administering nitrates.
Purpose:
- To investigate the therapeutic utility of blood pressure reduction using nitrates in hypertensive patients.
- To evaluate the acute and long-term hemodynamic effects of nitrates.
Summary:
- Acute hemodynamic experiments with glycerol trinitrate in hypertensive patients showed reduced blood pressure and resistance, similar to effects in normotensive individuals but more pronounced.
- Clinical trials demonstrated glycerol trinitrate's favorable effects in hypertensive crises with cerebral and/or cardiac complications.
- Initial findings on long-term pentaerythrityl tetranitrate use in severe hypertension are inconclusive regarding efficacy and indications.
Impact:
- Confirms the acute benefits of nitrates in managing hypertensive emergencies and reducing vascular resistance.
- Highlights the need for further research into the long-term effectiveness and specific indications for nitrate therapy in hypertension.
Abstract:
Taking into consideration the frequent combination of hypertension, ischaemic heart disease and heart insufficiency the effect of blood pressure as well as the influence of pre- and afterload gain increasing importance, when nitrates are used. It is the question, whether the blood pressure reducing effect may be used with a certain aim or not. In own investigations acute haemodynamic experiments with glycerol trinitrate were carried out on 10 patients with arterial hypertension (catheterization, estimation of HMV and so on) in rest and under ergometric load, clinical therapeutic experiments on 10 patients with crisis of hypertension with cerebral and/or cardiac complications as well as long-term experiments with pentaerythrityl tetranitrate on 6 patients with in most cases severe arterial hypertension. The acute effects on the haemodynamics correspond to those in normal blood pressure, in which case the reduction of blood pressure and resistance is more expressed. The favourable effect of glycerol trinitrate in the crisis of hypertension with cardiovascular complications can be regarded as proved. First own experiences with the long-term application of nitrates do not yet result in a clear estimation of effectivity and indications.