Use of nitrates in ischemic heart disease.

Abstract

Short-acting nitrates are beneficial in acute myocardial ischemia. However, many unresolved questions remain about the use of long-acting nitrates in stable ischemic heart disease. The use of long-acting nitrates is weakened by the development of endothelial dysfunction and tolerance. Also, we currently ignore whether lower doses of transdermal nitroglycerin would be better than those presently used. Multivariate analysis data from large nonrandomized studies suggested that long-acting nitrates increase the incidence of acute coronary syndromes, while data from another multivariate study indicate that they have positive effects. Because of methodological differences and open questions, the two studies cannot be compared. A study in Japanese patients with vasospastic angina has shown that, when compared with calcium antagonists, long-acting nitrates do not improve long-term prognosis and that the risk for cardiac adverse events increases with the combined therapy. We have many unanswered questions.

• Authors: Cocco Giuseppe, Jerie Paul, Iselin Hans-Ulrich
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 16 Issue 11 Pg. 1567-72 ( 2015) ISSN: 1744-7666 [Electronic] England
• PMID: 26027641 (Publication Type: Editorial, Review)

Chemical References

• Delayed-Action Preparations
• Nitrates
• Nitroglycerin

Topics

• Angina Pectoris (drug therapy)
• Coronary Artery Disease (chemically induced, drug therapy)
• Delayed-Action Preparations
• Drug Tolerance
• Humans
• Myocardial Ischemia (drug therapy)
• Nitrates (administration & dosage, adverse effects, therapeutic use)
• Nitroglycerin