By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)
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Additional info for Advances in Nitrate Therapy
The ability to terminate the effect within a short period after termination of the infusion is crucial in the rapidly changing hemodynamic conditions which might accompany unstable angina. Only recently have agents of other classes (such as the ultrashort-acting 32 Unstable Angina Pectoris beta-blocker esmolol) been developed to achieve the same flexibility as is available with nitrates in rapidly changing conditions such as unstable angina pectoris. 1. Effect on Myocardial Metabolism in Unstable Angina Another effect which may playa role (although a limited one) in the anti-ischemic activity of nitrates is the effect on myocardial metabolism.
Two points should, however, be emphasized: 1. , stable and unstable angina pectoris. The extent, time course and interaction of these mechanisms may differ between angina pectoris and silent ischemia, but basically they resemble each other. 2. Silent ischemia impairs prognosis of patients with coronary artery disease and therefore should be treated. Naturally, nitrates were among the first agents evaluated for treatment of silent ischemia. Their investigation was intensified after it was realized that episodes of silent ischemia are often not preceded by acceleration of heart rate, and that beta-blockers may therefore not be effective.
Margolis et al  reported that observations on more than 1500 patients suggest that in the supine, properly hydrated patients intravenous nitroglycerin produces an initial rapid decrease in systolic, diastolic and mean blood pressure. During the subsequent 30-60 seconds blood pressure gradually returns to baseline. Left ventricular filling pressure initially falls, concomitantly with the systemic arterial pressure, but it continues to fall when the systemic arterial pressure returns to baseline levels.
Advances in Nitrate Therapy by Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)