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ARTICLE |

Long-Acting Nitrates in the Treatment of Angina Pectoris FREE

Nathaniel Reichek, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association, edited by Richard L. Popp, MD.

Reprint requests to Cardiovascular Section, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19105 (Dr Reichek).


JAMA. 1976;236(12):1399-1402. doi:10.1001/jama.1976.03270130057037
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"LONG-ACTING" nitrates are widely regarded as a mainstay of medical therapy for angina pectoris, but their efficacy and duration of action remain controversial. Moreover, a confusing variety of nitrate preparations is currently available (Table). Now that other effective modes of angina prophylaxis exist (for example, propranolol hydrochloride or coronary bypass surgery), a critical awareness of the usefulness and limitations of long-acting nitrates is all the more important. This review will outline nitrate pharmacology and propose a practical approach to the rational selection of an effective nitrate regimen for the individual patient.

The therapeutic effectiveness of sublingual nitroglycerin in typical angina pectoris is clear-cut and undisputed. Administration of an effective dose during anginal pain clearly reduces the duration of the episode if the patient's untreated angina normally persists long enough for sublingual nitroglycerin to take effect. While this effect is helpful and reas

REFERENCES

Goldstein RE, Rosing DR, Redwood DR, et al:  Clinical and circulatory effects of isosorbide dinitrate . Circulation 43:629-640, 1971;.
Ganz W, Marcus HS:  Failure of intracoronary nitroglycerin to alleviate pacing-induced angina . Circulation 46:880-889, 1972;.
Needleman P, Blehm DJ, Rotskoff KS:  Relationship between glutathione-dependent denitration and the vasodilator effectiveness of organic nitrates . J Pharmacol Exp Ther 165:286-288, 1968;.
Klaus A, Zaert BL, Pitt BL, et al:  Comparative evaluation of sublingual long acting nitrates in angina pectoris . Circulation 48:519-525, 1973;.
Redwood DR, Rosing DR, Goldstein RE, et al:  Importance of the design of an exercise protocol in the evaluation of patients with angina pectoris . Circulation 43:618-628, 1971;.
Needleman P, Lang S, Johnson EM Jr:  Organic nitrates: Relationship between biotransformation and rational angina pectoris therapy . J Pharmacol Exp Ther 181:489-497, 1972;.
Reichek N, Goldstein RE, Redwood DR, et al:  Sustained effects of nitroglycerin ointment in patients with angina pectoris . Circulation 50:348-352, 1974;.
Lange RL, Reid MS, Tresch DD, et al:  Nonatheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerin exposure . Circulation 46:666-678, 1972;.

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Goldstein RE, Rosing DR, Redwood DR, et al:  Clinical and circulatory effects of isosorbide dinitrate . Circulation 43:629-640, 1971;.
Ganz W, Marcus HS:  Failure of intracoronary nitroglycerin to alleviate pacing-induced angina . Circulation 46:880-889, 1972;.
Needleman P, Blehm DJ, Rotskoff KS:  Relationship between glutathione-dependent denitration and the vasodilator effectiveness of organic nitrates . J Pharmacol Exp Ther 165:286-288, 1968;.
Klaus A, Zaert BL, Pitt BL, et al:  Comparative evaluation of sublingual long acting nitrates in angina pectoris . Circulation 48:519-525, 1973;.
Redwood DR, Rosing DR, Goldstein RE, et al:  Importance of the design of an exercise protocol in the evaluation of patients with angina pectoris . Circulation 43:618-628, 1971;.
Needleman P, Lang S, Johnson EM Jr:  Organic nitrates: Relationship between biotransformation and rational angina pectoris therapy . J Pharmacol Exp Ther 181:489-497, 1972;.
Reichek N, Goldstein RE, Redwood DR, et al:  Sustained effects of nitroglycerin ointment in patients with angina pectoris . Circulation 50:348-352, 1974;.
Lange RL, Reid MS, Tresch DD, et al:  Nonatheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerin exposure . Circulation 46:666-678, 1972;.
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