Circulation, Vol 76, 577-584, Copyright © 1987 by American Heart Association
U Elkayam, D Kulick, N McIntosh, A Roth, W Hsueh and SH Rahimtoola
Sustained therapy with nitroglycerin (NTG) has been reported to provoke the
development of early tolerance. Because continuous intravenous NTG infusion
is commonly used in patients with coronary artery disease and heart
failure, we evaluated the incidence of early tolerance developed within the
first 24 hr of therapy in 31 responders to NTG. After documentation of
response to NTG, defined as a 10 mm Hg or greater or a 30% or greater
reduction in mean pulmonary arterial wedge pressure (PAWP), 16 patients
were blindly, randomly assigned to receive placebo and 15 patients were
continued on same-dose NTG. Both groups showed an identical fall in PAWP at
peak NTG titration (11 +/- 4 mm Hg). Discontinuation of NTG in the placebo
group resulted in a rapid increase in PAWP to levels not significantly
different from baseline (19 +/- 5 mm Hg at 2 hr vs 23 +/- 6 mm Hg at
baseline; p = NS). In the NTG group, PAWP fell from 27 +/- 9 to 14 +/- 7 mm
Hg, was 16 +/- 9 mm Hg at 2 hr (p less than .05 vs baseline), and continued
to be significantly lower than baseline for 8 hr; however, due to
attenuation of effect, PAWP values at 12, 20, and 24 hr were not
significantly different from placebo or baseline values.(ABSTRACT TRUNCATED
AT 250 WORDS)
ARTICLES
Incidence of early tolerance to hemodynamic effects of continuous infusion of nitroglycerin in patients with coronary artery disease and heart failure
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