This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Jonathan Abrams, MD

JAMA. 1988;259(3):396-401.

Abstract
Nitroglycerin and the long-acting nitrates are beneficial in stable and unstable angina pectoris and acute myocardial infarction and as adjunctive therapy in congestive heart failure. Nitroglycerin compounds relax vascular smooth muscle, producing venous, arterial, and arteriolar dilatation. These actions are modulated by stimulation of intracellular cyclic guanosine monophosphate. Nitrate efficacy in ischemic heart disease is due to peripheral venous and arterial vasodilatation that results in decreased myocardial oxygen consumption. Nitrates also dilate coronary arteries and collaterals, reverse coronary vasoconstriction, and enlarge some coronary atherosclerotic lesions. Nitrates improve exercise performance in stable angina pectoris. Intravenous nitroglycerin should be used in the initial treatment of unstable angina. Nitrates may be beneficial in myocardial infarction for control of ischemic pain, acute hypertension, and left ventricular failure. In subjects with congestive heart failure, nitrates reduce symptoms and improve exercise tolerance. Nitrate tolerance is a problem with continuous nitrate therapy. Tolerance is most likely to occur with frequent dosing or the use of long-acting nitrates, particularly transdermal nitroglycerin disks, and can be prevented or reversed with intermittent-dosing regimens.

(JAMA 1988;259:396-401)

Author Affiliations
From the Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque.

Footnotes
This article is one of a series sponsored by the American Heart Association.

Reprint requests to Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131 (Dr Abrams).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Role of Mitochondrial Aldehyde Dehydrogenase in Nitroglycerin-Induced Vasodilation of Coronary and Systemic Vessels: An Intact Canine Model
Zhang et al.
Circulation 2004;110:750-755.
ABSTRACT | FULL TEXT  

Cyclic GMP Phosphodiesterases and Regulation of Smooth Muscle Function
Rybalkin et al.
Circ. Res. 2003;93:280-291.
ABSTRACT | FULL TEXT  

Upregulation of Phosphodiesterase 1A1 Expression Is Associated With the Development of Nitrate Tolerance
Kim et al.
Circulation 2001;104:2338-2343.
ABSTRACT | FULL TEXT  

Persistent Inhibition of Platelets During Continuous Nitroglycerin Therapy Despite Hemodynamic Tolerance
Hebert et al.
Circulation 1997;95:1308-1313.
ABSTRACT | FULL TEXT  

Long-term Angiotensin-Converting Enzyme Inhibition With High-Dose Enalapril Retards Nitrate Tolerance in Large Epicardial Arteries and Prevents Rebound Coronary Vasoconstriction In Vivo
Munzel and Bassenge
Circulation 1996;93:2052-2058.
ABSTRACT | FULL TEXT