Nitrate tolerance. A review of the evidence.

摘要: Organic nitrates are well established in the treatment of a wide variety cardiovascular disorders, most notably angina pectoris and congestive heart failure. However, attenuation of, or tolerance to, haemodynamic anti-ischaemic effects may occur with all long-acting nitrate formulations. In majority patients continuous administration long acting tends to promote development attenuation, while intermittent avoids it. Likewise, higher-doses appear induce greater degree than lower doses. Attenuation exercise failure patients, clinical end-points appears be less testing patients. While use therapy it expose patient an as yet undefined risk silent and/or symptomatic anginal episodes occurring during nitrate-free interval. role concomitant avoiding this potential remains defined. Means include coadministration sulfhydryl donors such N-acetylcysteine. Alternatively, angiotension-converting enzyme (ACE) inhibitors captopril block renin-angiotensin system-induced reflex sympathetic stimulation. lesser individual The proportion attenuators vs non-attenuators defined, does means identifying prospectively by laboratory parameters. Conflicting results among smaller studies reflect variable proportions non-attenuators. conflicting larger differences selection criteria, selecting positive reproducible stress tests little way spontaneously versus but frequent induced angina. former group pure fixed coronary artery disease vasospasm, change vasomotor tone, latter variability tone more plaque instability. efficacy might therefore expected greatest those numbers episodes. Recent data suggest that have important direct on vessels including dilating eccentric stenoses, intercoronary collateral channels having diseased segments opposed segments.(ABSTRACT TRUNCATED AT 400 WORDS)