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Use of Nitrates as Antianginal Agents

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Abstract

Angina pectoris due to coronary artery disease is generally considered to be chest pain due to myocardial ischemia which occurs because the myocardial oxygen demand exceeds the myocardial oxygen supply. An effective antianginal agent should relieve anginal pain either by improving the myocardial oxygen supply or by reducing the myocardial oxygen demand. In addition to relieving anginal pain, an ideal antianginal drug would also increase exercise performance, reduce electrocardiographic evidence of myocardial ischemia, prevent myocardial infarction, and prolong life. The following discussion will critically evaluate the efficacy of the nitrites as antianginal drugs.

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References

  • Aronow, W.S.: Drug evaluation—Chronic trials, in Ross, R.S. and Hoffman, F., editors: Myocardial Ischemia, International Congress Series No. 225, Amsterdam, 1971, Excerpta Medica, pp. 73–82.

    Google Scholar 

  • Aronow, W. S.: The medical treatment of angina pectoris II. Design of an antianginal drug study. Amer. Heart J. 84, 132–134 (1972a).

    Article  PubMed  CAS  Google Scholar 

  • Aronow, W.S.: Medical treatment of angina pectoris. III. Pharmacology of sublingual nitrites as antianginal drugs. Amer. Heart J. 84, 273–275 (1972b).

    Article  PubMed  CAS  Google Scholar 

  • Aronow, W.S.: The medical treatment of angina pectoris. IV. Nitroglycerin as an antianginal drug. Amer. Heart J. 8, 415–418 (1972c).

    Article  Google Scholar 

  • Aronow, W.S.: The medical treatment of angina pectoris. V. Long-acting nitrites as antianginal drugs. Amer. Heart J. 84, 567–569 (1972d).

    Article  CAS  Google Scholar 

  • Aronow, W.S.: The medical treatment of angina pectoris. IX. The medical management of angina pectoris. Amer. Heart J. 85, 275–278 (1973a).

    Article  CAS  Google Scholar 

  • Aronow, W.S.: Management of stable angina. New Engl. J. Med. 289, 516–520 (1973b).

    Article  PubMed  CAS  Google Scholar 

  • Aronow, W.S., Chesluk, H.M.: Sublingual isosorbide dinitrate therapy versus sublingual placebo in angina pectoris. Circulation 41, 869–874 (1970a).

    PubMed  CAS  Google Scholar 

  • Aronow, W.S., Chesluk, H.M.: Evaluation of nitroglycerin in angina in patients on isosorbide dinitrate. Circulation 42, 61–63 (1970b).

    PubMed  CAS  Google Scholar 

  • Aronow, W.S., Kaplan, M.A.: Evaluation of propranolol and of isosorbide dinitrate in angina pectoris. Curr. Ther. Res. 11, 80–86 (1969).

    PubMed  CAS  Google Scholar 

  • Battock, D.J., Alvarez, H., Chidsey, C.A.: Effect of propranolol and isosorbide dinitrate on exercise performance and adrenergic activity in patients with angina pectoris. Circulation 39, 157–169 (1969).

    PubMed  CAS  Google Scholar 

  • Battock, D. J., Chidsey, C.A.: Isosorbide dinitrate in angina. Circulation 44, 1147 (1971) (Letter to the Editor).

    PubMed  CAS  Google Scholar 

  • Bernstein, L., Friesinger, G.C., Lichtlen, P.R., Ross, R.S.: The effect of nitroglycerin on the systemic and coronary circulation in man and dogs. Myocardial blood flow measured with xenon. Circulation 33, 107–116 (1966).

    PubMed  CAS  Google Scholar 

  • Burch, G.E., DePasquale, N.P.: Fresh nitroglycerin (glyceryl trinitrate). Amer. Heart J. 72, 842 (1966).

    Article  PubMed  CAS  Google Scholar 

  • Cole, S.L., Kaye, H., Griffith, G. C.: Assay of anti-anginal agents I. A curve analysis with multiple control periods. Circulation 15, 405–413 (1957).

    PubMed  CAS  Google Scholar 

  • Cole, S.L., Kaye, H., Griffith, G. C.: Assay of antianginal agents. A long-acting nitrate, psychic energizers and a tranquilizer. Amer. J. Cardiol. 11, 639–645 (1963).

    Article  PubMed  CAS  Google Scholar 

  • Dagenais, G.R., Mason, R.E., Friesinger, G.C., Wender, C., Ross, R.S.: Exercise tolerance in patients with angina pectoris: Daily variation and effect of pentaerythritol tetranitrate. John Hopkins med. J. 125, 301–311 (1969).

    CAS  Google Scholar 

  • Detry, J.M., Bruce, R.A.: Effects of nitroglycerin on “maximal” oxygen intake and exercise electrocardiogram in coronary heart disease. Circulation 43, 155–163 (1971).

    PubMed  CAS  Google Scholar 

  • Dewar, H.A., Horler, A.R., Newell, D.J.: A clinical trial of penta-erythritol tetranitrate, a khellin derivative (recordil), and iproniazid in angina of effort. Brit. Heart J. 21, 315–322 (1959).

    Article  PubMed  CAS  Google Scholar 

  • Evans, W., Hoyle, C.: The comparative value of drugs used in the continuous treatment of angina pectoris. Quart. J. med. 2, 311–338 (1933).

    Google Scholar 

  • Fisch, S., DeGraff.A.C.: Coronary vasodilators. Dis Chest 44, 533–537 (1963).

    Article  PubMed  CAS  Google Scholar 

  • Freis, E.D., Gaffney, T.E., Kirkendall, W., Marcus, F. I., Nickerson, M., Pearce, M.L.: Report of the panels on cardiovascular drugs from the drug efficacy study. Circulation 41, 149–151 (1970).

    Google Scholar 

  • Friend, D.G., O’Hare, J.P., Levine, H.D.: Action of triethanolamine trinitrate in angina pectoris. Amer. Heart J. 48, 775–779 (1954).

    Article  PubMed  CAS  Google Scholar 

  • Ganz, W., Marcus, H.S.: Failure of intracoronary nitroglycerin to alleviate pacing-induced angina. Circulation 46, 880–889 (1972).

    PubMed  CAS  Google Scholar 

  • Goldbarg, A.N., Moran, J.F., Butterfield, T.K., Nemickas, R., Bermudez, G.A.: Therapy of angina pectoris with propranolol and long-acting nitrates. Circulation 40, 847–853 (1969).

    CAS  Google Scholar 

  • Goldstein, R.E., Redwood, D.R., Epstein, S.E.: Isosorbide dinitrate in angina. Circulation 44, 1148–1149 (1971) (Letter to the Editor).

    Google Scholar 

  • Goldstein, R.E., Rosing, D.R., Redwood, D.R., Beiser, G.D., Epstein, S.E.: Clinical and circulatory effects of isosorbide dinitrate: comparison with nitroglycerin. Circulation 43, 629–640 (1971).

    PubMed  CAS  Google Scholar 

  • Gorlin, R., Brachfeld, N., MacLeod, C., Bopp, P.: Effect of nitroglycerin on the coronary circulation in patients with coronary artery disease or increased left ventricular work. Circulation 19, 705–718 (1959).

    PubMed  CAS  Google Scholar 

  • Horwitz, L.D., Gorlin, R., Taylor, W.J., Kemp, H.G.: Effects of nitroglycerin on regional myocardial blood flow in coronary artery disease. J. clin. Invest. 50, 1578–1584 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Horwitz, L.D., Herman, M.V., Gorlin, R.: Clinical response to nitroglycerin as a diagnostic test for coronary artery disease. Amer. J. Cardiol. 29, 149–153 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Kalmanson, G.M., Drenick, E.J., Binder, M. J., Rosove, L.: Pentaerythritol tetranitrate in the treatment of angina pectoris. Arch. intern. med. 95, 819–822 (1955).

    CAS  Google Scholar 

  • Klaus, A., Zaret, B., Pitt, B., Ross, R.S.: Comparative evaluation of sublingual long acting nitrates in angina pectoris. Amer. J. Cardiol. 31, 142 (1973) (Abstract).

    Article  Google Scholar 

  • Lange, R.L., Reid, M.S., Tresch, D.D., Keelan, M.H., Bernhard, V.M., Coolidge, G.: Nonatheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerin exposure. Circulation 46, 666–678 (1972).

    PubMed  CAS  Google Scholar 

  • Livesley, B., Catley, P.F., Campbell, R.C., Oram, S.: Double-blind evaluation of verapamil, propranolol, and isosorbide dinitrate against a placebo in the treatment of angina pectoris. Brit. med. J. 1973 I, 375–378.

    Article  Google Scholar 

  • MacAlpin, R.N., Alvaro, A.B., Kattus, A.A.: Effect of propranolol and nitroglycerin on exercise tolerance in angina pectoris, in Kattus, A. A., Ross, G., Hall, V., editors: UCLA forum in medical sciences No. 13. Cardiovascular beta adrenergic responses, pp. 191–203. Berkeley-Los Angeles-London: University of California Press 1970.

    Google Scholar 

  • Mason, D.T., Braunwald, E.: The effects of nitroglycerin and amyl nitrite on arteriolar and venous tone in the human forearm. Circulation 32, 755–766 (1961).

    Google Scholar 

  • Master, A.M., Jaffe, H.L., Dack, S.: The drug treatment of angina pectoris due to coronary artery disease. Amer. J. med. Sci 197, 774–782 (1939).

    Article  Google Scholar 

  • Modell, W.: Clinical pharmacology of antianginal drugs. Clin. pharm. Ther. 3, 97–108 (1962).

    CAS  Google Scholar 

  • Needleman, P.: Tolerance to the vascular effects of glyceryl trinitrate. J. Pharmacol. exp. Ther. 171, 98–102 (1970).

    PubMed  CAS  Google Scholar 

  • Needleman, P.: Oral nitrates: Efficacious? Ann. intern. med. 78, 458 (1973).

    Google Scholar 

  • Needleman, P., Lang, S., Johnson, E. M.: Organic nitrates: relationship between biotransformation and rational angina pectoris therapy. J. Pharmacol. exp. Ther. 181, 489–497 (1972).

    PubMed  CAS  Google Scholar 

  • Nickerson, M.: Vasodilator drugs. In Goodman, L.S. and Gilman, A. (Eds.): The Pharmacological Basis of Therapeutics, p. 748. New York: Macmillan Co. 1965.

    Google Scholar 

  • Oram, S., Sowton, E.: Failure of propatylnitrate and pentaerythritol tetranitrate to prevent attacks of angina pectoris. Brit. med. J. 1961 II, 1745–1746.

    Article  Google Scholar 

  • Parker, J.O., West, R.P., DiGiorgi, S.: The effect of nitroglycerin on coronary blood flow and the hemodynamic response to exercise in coronary artery disease. Amer. J. Cardiol. 27, 59 – 65 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Riseman, J.E.F., Brown, M.G.: The duration of attacks of angina pectoris on exertion and the effect of nitroglycerin and amyl nitrite. New Engl. J. med. 217, 470–473 (1937).

    Article  Google Scholar 

  • Rowe, G.G.: Coronary vasodilator therapy for angina pectoris. Amer. Heart J. 68, 691–696 (1964).

    Article  PubMed  CAS  Google Scholar 

  • Rowe, G.G., Chelius, C.J., Afonso, S., Gurtner, H.P., Crumpton, C.W.: Systemic and coronary hemodynamic effects of erythrol tetranitrate. J. clin. Invest. 40, 1217–1222 (1961).

    Article  PubMed  CAS  Google Scholar 

  • Russek, H.I.: Propranolol and isosorbide dinitrate synergism in angina pectoris. Amer. J. Cardiol. 21, 44–54 (1968).

    Article  PubMed  CAS  Google Scholar 

  • Sandler, G., Ilahi, M.A., Lawson, C.W.: Glyceryl trinitrate in angina pectoris. Lancet 1963 I, 1130–1136.

    Article  Google Scholar 

  • Schelling, J.L., Lasagna, L.: A study of cross-tolerance to circulatory effects of organic nitrates. Clin. pharm. Ther. 8, 256–260 (1967).

    CAS  Google Scholar 

  • Stipe, A.A., Fink, G.B.: Prophylactic therapy of angina pectoris with organic nitrates: Relationship of drug efficacy and clinical experimental design. J. clin. Pharmacol. 13, 244–250 (1973).

    PubMed  CAS  Google Scholar 

  • Wang, J., Mathur, V.S., Messer, J. V.: Nitroglycerine induced flow maldistribution in coronary stenosis. Circulation 44 (Suppl II). 59 (1971) (Abstract).

    Google Scholar 

  • Williams, J. F., Jr., Glick, G., Braunwald, E.: Studies on cardiac dimensions in intact unanesthetized man. V. Effects of nitroglycerin. Circulatipn 32, 767–771 (1965).

    CAS  Google Scholar 

  • Willis, P.W. III, Duff, I. F.: Coronary vasodilating drugs. Med. clin. N. Amer. 41, 449–469,1957.

    PubMed  Google Scholar 

  • Zelis, R., Mason, D.T.: Demonstration of nitrite tolerance: Attenuation of the vasodilator response to nitroglycerin by the chronic administration of isosorbide dinitrate. Circulation 40 (Suppl. III), 221 (1969) (Abstract).

    Google Scholar 

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© 1975 Springer-Verlag Berlin · Heidelberg

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Aronow, W.S. (1975). Use of Nitrates as Antianginal Agents. In: Needleman, P. (eds) Organic Nitrates. Handbuch der experimentellen Pharmakologie / Handbook of Experimental Pharmacology, vol 40. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-66024-5_9

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  • DOI: https://doi.org/10.1007/978-3-642-66024-5_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-66026-9

  • Online ISBN: 978-3-642-66024-5

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