74897
document
Control of perioperative hypertension during coronary artery surgery . A randomised double-blind study comparing isosorbide dinitrate and nitroglycerin . A reduction in the causes of myocardial ischaemia remains of prime importance during coronary artery surgery . Hypertension with the ensuing increase in myocardial oxygen demand is a major factor in the aetiology of perioperative myocardial ischaemia . Nitroglycerin ( NTG ) has long been used beneficially to reduce myocardial oxygen demand by its effects on the systemic and peripheral vascular resistances . An alternative nitrate , isosorbide dinitrate ( ISDN ) is now available as an intravenous preparation , and may offer technical advantages , both due to its stability in solution and also its longer in vivo half-life . We designed and carried out a multi-centre study to compare and evaluate the efficacy of ISDN and NTG in the management of perioperative hypertension in 85 patients undergoing elective coronary artery surgery . A total of 288 events in which the systolic blood pressure ( SBP ) exceeded a predetermined trigger value were observed . ISDN was successful in treating hypertension in 63 % of the events , whereas NTG had an 83 % success . The SBP was significantly lowered after treatment with either ISDN , 155 mmHg to 138 mmHg , or NTG , 160 mmHg to 130 mmHg . The mean successful dose rate for ISDN was 6.5 micrograms kg-1 min-1 , whereas for NTG this was 3.8 micrograms kg-1 min-1 . In the ISDN group less events took place possibly due to the longer duration of this drug . In many previous studies NTG has been found to be effective in controlling hypertension ; ISDN offers and alternative approach in reducing hypertension .
74898
Intervention_Surgical
coronary artery surgery
74899
Intervention_Pharmacological
isosorbide dinitrate
74900
Intervention_Pharmacological
nitroglycerin
74901
Intervention_Pharmacological
Nitroglycerin ( NTG )
74902
Intervention_Pharmacological
nitrate
74903
Intervention_Pharmacological
isosorbide dinitrate ( ISDN )
74904
Intervention_Pharmacological
ISDN
74905
Intervention_Pharmacological
NTG
74906
Intervention_Surgical
elective coronary artery surgery
74907
Intervention_Pharmacological
ISDN
74908
Intervention_Pharmacological
NTG
74909
Intervention_Pharmacological
ISDN
74910
Intervention_Pharmacological
NTG
74911
Intervention_Pharmacological
ISDN
74912
Intervention_Pharmacological
NTG
74913
Outcome_Physical
hypertension
74914
Outcome_Physical
myocardial ischaemia
74915
Outcome_Physical
Hypertension
74916
Outcome_Physical
myocardial oxygen demand
74917
Outcome_Physical
myocardial ischaemia
74918
Outcome_Physical
myocardial oxygen demand
74919
Outcome_Other
efficacy of ISDN and NTG
74920
Outcome_Physical
systolic blood pressure ( SBP )
74921
Outcome_Other
successful
74922
Outcome_Physical
hypertension
74923
Outcome_Physical
SBP
74924
Outcome_Other
mean successful dose rate
74925
Outcome_Physical
events
74926
Outcome_Physical
hypertension
74927
Outcome_Physical
reducing hypertension
74928
Participant_Condition
coronary artery surgery
74929
Participant_Sample-size
85 patients
74930
Participant_Condition
undergoing elective coronary artery surgery