THERAPY OF ANGINA-PECTORIS WITH LONG-ACTING NITRATES - WHICH AGENT AND WHEN

Nitroglycerin and the long-acting nitrates are effective antianginal a gents that have been used in clinical medicine for over 100 years. The se drugs are reliable, safe, familiar to clinicians, inexpensive, and easy to use. Side effects are limited to headache and postural hypoten sive symptoms. Nitrate tolerance or attenuation, - ie, loss of, or dec rease in, nitrate efficacy with repeated dosing is common and represen ts the major drawback to chronic therapy. Carefully designed dosing re gimens and/or appropriate use of nitrate formulations (to include a ni trate free period each day) will decrease or eliminate the problem of nitrate tolerance. In head-on comparative studies, nitrates appear to be as effective as betablockers or calcium channel blockers in the mon otherapy of chronic angina. Ideal patient characteristics for nitrate therapy include: predictably favourable response of chest pain to subl ingual nitroglycerin; angina episodes suggestive of coronary vasoconst riction or spasm; left ventricular systolic dysfunction; symptoms of c ongestive heart failure (systolic or diastolic dysfunction).