By Adam Schneeweiss MD, Marija Weiss DSc (auth.)
Nitrates were for a few years the cornerstone of cardiovascular treatment for numerous symptoms. not just have nitrates stood the try of time for therapy of persistent solid angina pectoris, however the symptoms for them have markedly ex panded. They now contain all varieties of angina pectoris and myocardial ischemia, congestive middle failure and hypertensive emergencies. The precious results of nitrates in a lot of these stipulations end result from their vasodilatory homes, however it continues to be doubtful no matter if the principal or peripheral results predominate within the thera peutic mechanism. lately nitrates were proven to meet an important requirement for every and each drug - to lessen mortality. a wide scale learn published that isosorbide dinitrate, mixed with hydralazine, diminished long term mortality via 28% in sufferers with congestive center failure. This discovering will surely stimulate study on nitrates, and it would be anticipated that curiosity in those medicinal drugs will markedly elevate. The essentially used nitrates in medical perform are nitroglycerin and the com plex natural nitrates, mostly isosorbide dinitrate. The natural mononitrates are actually below scientific research, and isosorbide-5-mononitrate (IS-5-MN) seems to be in particular promising.
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3. Beta-Adrenoreceptor Blockers Beta-adrenoreceptor blockers are first line antihypertensive agents. They have also a potent anti-anginal effect attributed to lowering of myocardial oxygen demand due to slowing of heart rate, decrease of contractility, lowering of blood pressure and other mechanisms of minor importance [70h, 70i, 70g, 70k]. Beta-adrenoreceptor blockers are excellent antianginal drugs in hypertensive patients and in the majority of normotensive patients. ' This problem was not addressed in most studies evaluating betablockers in angina pectoris, as hypotensive patients were excluded and the results were not analyzed in relation to pretreatment blood pressure.
This is probably due to the fact that this formulation does not allow a build-Up of constantly high plasma levels for 24 h. Silber et al  compared in a randomized study two groups of patients with chronic stable angina pectoris who received ISDN, 80 mg, in an oral sustained release form, for 2 weeks, either once or twice daily. tricular ejection fraction measured by radionuclide ventriculography. None of the ten patients who received the drug once daily showed any signs of attenuation of the anti-ischemic effect.
Nifedipine causes edema in about 20% of the patients. Headache, which often accompanies the initiation of nitrate therapy might be intolerable in some patients. No large-scale studies have specifically compared the frequency of adverse effects of the three classes of antianginal agents. 10. Nitrates and Diagnostic Procedures in Patients with Coronary Artery Disease The anti-ischemic effect of nitrates may increase the sensitivity of radionuclide studies in detecting viable myocardium in patients with coronary artery disease.