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document
Influence of glyceryl trinitrate on venous and arterial effects of chronic , asymmetric isosorbide dinitrate treatment in patients with ischemic heart disease . Asymmetric dosage regimes have been introduced to circumvent development of nitrate tolerance . This study assessed invasively the hemodynamics during supine rest and exercise before and after 4 weeks treatment with 30 mg isosorbide dinitrate ( ISDN ) or placebo asymmetrically b.i.d . in 14 randomized patients with stable ischemic heart disease in a double-blinded study . An intravenous infusion of glyceryl trinitrate ( GTN ) was used to assess possible nitrate tolerance . During the initial , medication-free exercise all patients had increased pulmonary arterial wedge pressure ( PAWP ) 31.4 +/- 5.56 mmHg ( mean +/- SD ) , showing impaired left ventricular function , while mean arterial pressures ( MAP ) rose from 112 +/- 16.3 mmHg at rest to 141 +/- 15.9 mmHg during exercise . After 4 weeks ISDN treatment , mean exercise PAWP and MAP , 3 h after morning dose , were reduced to 22.4 +/- 7.09 mmHg and 127 +/- 18.2 mmHg , respectively . Before the ISDN treatment , GTN reduced exercise PAWP to 13.9 +/- 5.27 mmHg and MAP to 119 +/- 11.2 mmHg , whereas after 4 weeks ISDN treatment , the addition of GTN did not reduce exercise PAWP and MAP to the same low levels . Thus , the applied ISDN regimen improved the hemodynamics , but induced a definite , partial nitrate tolerance .
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Intervention_Pharmacological
glyceryl trinitrate
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Intervention_Pharmacological
isosorbide dinitrate treatment
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Intervention_Pharmacological
30 mg isosorbide dinitrate ( ISDN ) or
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Intervention_Control
placebo
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Intervention_Pharmacological
glyceryl trinitrate ( GTN )
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Intervention_Pharmacological
ISDN
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Intervention_Pharmacological
ISDN treatment , GTN
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Intervention_Pharmacological
ISDN
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Intervention_Pharmacological
ISDN
84435
Outcome_Physical
pulmonary arterial wedge pressure ( PAWP )
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Outcome_Physical
mean arterial pressures ( MAP )
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Outcome_Physical
mean exercise PAWP
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Outcome_Mental
and
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Outcome_Physical
MAP
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Outcome_Physical
PAWP
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Outcome_Physical
PAWP
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Outcome_Mental
and
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Outcome_Physical
MAP
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Participant_Condition
ischemic heart disease
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Participant_Sample-size
14