HEMODYNAMIC-EFFECTS OF NICORANDIL COMPARE D TO ISOSORBITOL-5-MONONITRATE IN PATIENTS WITH CORONARY HEART-DISEASE

Nicorandil is a potassium-channel opener in the therapy of coronary he art disease. In addition to a nitrate-like effect, hyperpolarisation o f the cell membrane by opening of potassium channels leads to relaxati on of vascular smooth muscles. In a randomized, double-blind study in 30 patients with angiographically prooven coronary heart disease, effi cacy of nicorandil (group 1) was compared to isosorbitol-5-mononitrate (ISMN, group 2). Hemodynamics in rest and during exercise were measur ed on the first day of treatment and in a subchronic phase (12 +/- 4 d ays), each time immediately before and two hours after application. Re sults: Main hemodynamic variables, i.e. diastolic pulmonary arterial p ressure and mean pulmonary capillary pressure were decreased significa ntly in both groups on the first day; there was no significant differe nce between both substances. In both groups, a small, not significant decrease of systolic and diastolic blood pressure was observed, heart rate and cardiac index were not significantly changed. In subchronic p hase, these results were confirmed. Conclusion: Nicorandil is a new su bstance for the treatment of coronary heart disease with favourable he modynamic effects comparable to nitrates. As it possesses a dual mecha nism of drug action and lacking evidence for the development of a drug -tolerance, nicorandil may demonstrate advantages compared to nitrates .