Nitrates Compared and Combined with Other Antianginal Drugs

Abstract

As nitrates were introduced to clinical practice before all other classes of antianginal drugs, the development of new classes of drugs should have been followed by comparative trials with nitrates. The situation was complicated, however, by several factors. When beta-adrenoreceptor blockers were developed and introduced to clinical practice, organic nitrates were not in wide use for angina prophylaxis because of the mistaken belief that the first-pass hepatic degradation prevents orally administered organic nitrates from reaching the systemic circulation. Nitroglycerin was used only for relief of acute pain — an indication for which orally administered beta-blockers are ineffective. Long-acting nitroglycerin formulations and transdermal nitroglycerin patches were not available until 4 years ago. Therefore there are very few comparative studies of beta-blockers and nitrates in angina pectoris. Many comparative studies of nitrates and calcium antagonists have, however, been performed, most of these with ISDN.