Hemodynamic effects of concomitant nitroglycerin ointment and nifedipine treatment in acute myocardial infarction

Nitroglycerin ointment and nifedipine were used concurrently for vasodilator therapy in 10 patients with acute myocardial infarction. Nitroglycerin ointment 20 mg (4 cm) induced a significant reduction in pulmonary capillary wedge pressure from 14.1 +/- 1.8 (mean +/- standard error of the mean) to 12.4 +/- 1.2 mmHg (p less than 0.05) 30 min after application, while cardiac output, mean blood pressure, and systemic vascular resistance did not show a significant change. When nifedipine 10 mg was added orally, mean blood pressure significantly decreased from 99.0 +/- 6.3 to 82.8 +/- 5.9 mmHg (p less than 0.005) and systemic vascular resistance from 25.7 +/- 1.5 to 19.2 +/- 1.6 units (p less than 0.001) 30 min after; on the other hand, cardiac index significantly increased from 2.28 +/- 0.12 to 2.57 +/- 0.14 l/min/m2 (p less than 0.001). From these results, it was concluded that combined use of these two drugs was a useful and safe form of unloading therapy.