By Adam Schneeweiss MD, Marija Weiss DSc (auth.)
Nitrates were for a few years the cornerstone of cardiovascular treatment for varied symptoms. not just have nitrates stood the try of time for remedy of persistent good angina pectoris, however the symptoms for them have markedly ex panded. They now contain all varieties of angina pectoris and myocardial ischemia, congestive center failure and hypertensive emergencies. The priceless results of nitrates in these kinds of stipulations consequence from their vasodilatory houses, however it continues to be uncertain even if the crucial or peripheral results predominate within the thera peutic mechanism. lately nitrates were proven to satisfy crucial requirement for every and each drug - to minimize mortality. a wide scale research printed that isosorbide dinitrate, mixed with hydralazine, diminished long term mortality via 28% in sufferers with congestive center failure. This discovering will surely stimulate examine on nitrates, and it would be anticipated that curiosity in those medicinal drugs will markedly bring up. The essentially used nitrates in scientific perform are nitroglycerin and the com plex natural nitrates, more often than not 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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Additional info for Advances in Nitrate Therapy
An ergometric test with incremental doses was performed 60 min after drug administration. The combination of nifedipine and IS-5-MN was superior to nifedipine alone in all the six patients with a positive test and superior to IS-5MN alone in all except one. These results support the hypothesis that nifedipine and nitrates may have additive anti anginal effects and that their combination is superior to either of these drugs alone in the prevention of coronary arterial spasm. Other investigators have not been able to confirm an additive antianginal efficacy of nitrates and calcium antagonists.
In order to characterize regional myocardial perfusion and glucose metabolism in unstable angina and the effect of ISDN on these parameters Araujo et al  studied 22 patients with angiographically proven coronary artery disease and severe unstable angina, using positron-emission tomography. Myocardial glucose utilization was found to be increased in these patients, even in the absence of acute myocardial necrosis, clinical signs of acute ischemia or detectable perfusion abnormalities. Intravenous administration of ISDN reduced myocardial oxygen utilization, suggesting a beneficial effect on myocardial metabolism.
3 per 24 h. However, only 36% of patients showed complete suppression of angina, whereas 43% of patients were refractory to treatment and required early coronary artery bypass surgery. An encouraging finding for ambulatory treatment was that the effect of intravenous nitroglycerin was similar to that of combined treatment with oral ISDN and nitroglycerin ointment. Kaplan et al  studied the effect of intravenous nitroglycerin in 35 patients with angina at rest refractory to oral and sublingual nitrates and beta-blockers.