Long-term nitrate therapy in coronary heart disease--loss of effect by developing tolerance
Dück, K.D.; Richard, F.
Zeitschrift für die Gesamte Innere Medizin und ihre Grenzgebiete 45(24): 736-741
1990
ISSN/ISBN: 0044-2542 PMID: 2129317 Document Number: 353873
The therapeutic efficiency of the long-term nitrates in coronary heart disease with exercise-induced heart insufficiency is recently more frequently called in question by observations of a nitrate tolerance. In own long-term studies on 34 patients with coronary heart disease with clinical and haemodynamic evidence (pathologic increase of the end-diastolic pressure of the pulmonary arteries under ergometric load) of an exercise-induced heart insufficiency the efficacy of pentaerythril tetranitrate (PETN) and isosorbide dinitrate (ISDN) in chronic dosage titration use was tested. The oral nitrate therapy evoked a clear decrease of the end-diastolic pressure of the pulmonary arteries. The reduction of the values of the pressure of the pulmonary arteries was correlated with adequate clinical findings (significant decrease of the frequency of pectanginous attacks and of the sublingual need of GTN, regression of the ST segment depression). The own results with particular valuation of the microcatherisation of the right heart on exertion plead against a clinically remarkable nitrate tolerance and confirm the efficiency of the at present usual basic medicamentous therapy in patients with coronary heart disease and exercise-induced heart insufficiency.