Document Detail

The insufficient nitrate response: patients' characterization and response to beta and calcium blockade.
MedLine Citation:
PMID:  3409909     Owner:  NLM     Status:  MEDLINE    
Little information has been published regarding the nitrate-induced changes of left ventricular volumes at rest and during exercise in relation to the degree of the anti-ischaemic response. Therefore we assessed the electrocardiographically defined nitrate response to a single tablet of 80 mg isosorbide dinitrate s.r. and compared it to the changes in end-diastolic volumes at rest and during exercise, as determined by radionuclide ventriculography. Thirty-four of the 63 patients were classified as good nitrate responders, whereas 29 patients showed insufficient nitrate response with regard to the reduction of exercise-induced ST-segment depression. The baseline characteristics were quite comparable. At rest the ISDN-induced decrease of the end-diastolic count rate was significantly less (-17%) in patients with insufficient ST-segment response when compared to patients with good ST-segment response (-25%). During exercise, in patients with good ST-segment response, ISDN reduced the end-diastolic volume significantly (-19%), whereas in patients with insufficient ST-segment response the end-diastolic volume remained unchanged. In this special subset of patients with insufficient nitrate response we further evaluated the effects of additional beta or/and calcium blockade. The benefits from verapamil were equivalent to propranolol. However, a considerable part of the patients investigated needed the combination of verapamil and propranolol for an optimal anti-ischaemic drug treatment. Thus, our data support the concept that preload reduction plays a major role for the anti-ischaemic effects of ISDN in patients with exercise-dependent ischaemia. Since, a suboptimal therapeutic effect must be considered, objective control of the nitrate therapy (usually by exercise- and Holter-ECG) must be regarded as obligatory for each individual patient if optimal results are to be expected.
S Silber; A C Vogler; F Spiegelsberger; M Vogel; K Theisen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European heart journal     Volume:  9 Suppl A     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1988 Jan 
Date Detail:
Created Date:  1988-10-11     Completed Date:  1988-10-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  125-34     Citation Subset:  IM    
Medizinische Klinik Innenstadt, Universität München, F.R.G.
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MeSH Terms
Coronary Disease / drug therapy*
Double-Blind Method
Drug Resistance
Drug Therapy, Combination
Exercise Test
Heart Rate / drug effects
Isosorbide Dinitrate / therapeutic use*
Middle Aged
Propranolol / therapeutic use*
Random Allocation
Stroke Volume / drug effects
Verapamil / therapeutic use*
Reg. No./Substance:
52-53-9/Verapamil; 525-66-6/Propranolol; 87-33-2/Isosorbide Dinitrate

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

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