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Potential problems with intermittent nitrate therapy

J D Parker1

  • 1Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario. jdp.inforamp.com@inforamp.net

The Canadian Journal of Cardiology
|May 1, 1996
PubMed
Summary
This summary is machine-generated.

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Intermittent organic nitrate therapy can lead to tolerance, potentially causing rebound angina or decreased exercise tolerance. Further research is needed to understand these effects and their clinical significance.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Organic nitrates are widely used for angina treatment.
  • Tolerance development is a known issue, often managed with nitrate-free intervals.
  • Intermittent transdermal nitroglycerin therapy may present unique challenges.

Purpose of the Study:

  • To investigate potential adverse effects of intermittent transdermal nitroglycerin therapy.
  • To explore the phenomena of rebound angina and decreased exercise tolerance during nitrate withdrawal.

Main Methods:

  • Review of prospective studies on intermittent transdermal nitroglycerin.
  • Confirmation of reduced exercise performance after nitroglycerin withdrawal in a laboratory setting.

Main Results:

  • Intermittent therapy may lead to crescendo angina (rebound angina) during nitrate-free periods.

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  • Transdermal nitroglycerin withdrawal was associated with reduced treadmill exercise performance for at least 6 hours.
  • Rebound ischemia and decreased exercise tolerance are not consistently observed across all studies.

    • Conclusions:

    • Potential for rebound angina and decreased exercise tolerance with intermittent nitrate therapy warrants further investigation.
    • These findings may offer insights into the pathophysiology of nitrate tolerance.
    • The clinical significance of decreased exercise tolerance needs further evaluation.