By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)
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Additional info for Advances in Nitrate Therapy
Thus the bulk of evidence indicates that vascular tolerance is only partial and segmental. The results of experimental studies on direct vascular effects cannot, therefore, be used to indicate frequent development of clinically significant tolerance to the therapeutic effect of nitrates. 2. Does Tolerance to the Antianginal Effect Chronic Therapy? 0/ ISDN Develop During As every clinician knows from his experience, ISDN is effective over years of treatment and without development of tolerance in many patients.
In contrast, in the ten patients treated with nitroglycerin alone a transient decrease in arterial pressure and a reflectory rise in heart rate were observed, while pulmonary capillary pressure showed a sustained decrease from 14 ± 2 to 8 ± 3 mmHg, and cardiac index was unchanged. Anginal symptoms were alleviated in both groups 15-30 min after initiation of the infusion and ceased within 2 h. These findings indicate that while both intravenous nifedipine and nitroglycerin are effective in unstable angina, their mechanisms of action differ.
Silent Ischemia The concept of silent ischemia has added a new and important indication to nitrate therapy. It is beyond the scope of this book to discuss silent ischemia. Two points should, however, be emphasized: 1. , stable and unstable angina pectoris. The extent, time course and interaction of these mechanisms may differ between angina pectoris and silent ischemia, but basically they resemble each other. 2. Silent ischemia impairs prognosis of patients with coronary artery disease and therefore should be treated.