Document Detail

Influence of glyceryl trinitrate on venous and arterial effects of chronic, asymmetric isosorbide dinitrate treatment in patients with ischemic heart disease.
MedLine Citation:
PMID:  8162628     Owner:  NLM     Status:  MEDLINE    
Asymmetric dosage regimes have been introduced to circumvent development of nitrate tolerance. This study assessed invasively the hemodynamics during supine rest and exercise before and after 4 weeks treatment with 30 mg isosorbide dinitrate (ISDN) or placebo asymmetrically b.i.d. in 14 randomized patients with stable ischemic heart disease in a double-blinded study. An intravenous infusion of glyceryl trinitrate (GTN) was used to assess possible nitrate tolerance. During the initial, medication-free exercise all patients had increased pulmonary arterial wedge pressure (PAWP) 31.4 +/- 5.56 mmHg (mean +/- SD), showing impaired left ventricular function, while mean arterial pressures (MAP) rose from 112 +/- 16.3 mmHg at rest to 141 +/- 15.9 mmHg during exercise. After 4 weeks ISDN treatment, mean exercise PAWP and MAP, 3 h after morning dose, were reduced to 22.4 +/- 7.09 mmHg and 127 +/- 18.2 mmHg, respectively. Before the ISDN treatment, GTN reduced exercise PAWP to 13.9 +/- 5.27 mmHg and MAP to 119 +/- 11.2 mmHg, whereas after 4 weeks ISDN treatment, the addition of GTN did not reduce exercise PAWP and MAP to the same low levels. Thus, the applied ISDN regimen improved the hemodynamics, but induced a definite, partial nitrate tolerance.
L H Jørgensen; H E Refsum; E Thaulow
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Clinical cardiology     Volume:  17     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-05-23     Completed Date:  1994-05-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  65-70     Citation Subset:  IM    
Department of Clinical Physiology, Ullevål Hospital, Oslo, Norway.
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MeSH Terms
Double-Blind Method
Drug Administration Schedule
Drug Interactions
Drug Tolerance
Exercise Test
Hemodynamics / drug effects*
Isosorbide Dinitrate / administration & dosage*
Middle Aged
Myocardial Ischemia / drug therapy*,  physiopathology
Nitroglycerin / pharmacology*
Reg. No./Substance:
55-63-0/Nitroglycerin; 87-33-2/Isosorbide Dinitrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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