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European Heart Journal 1992 13(9):1265-1270;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

A comparison of the day-long antianginal effectiveness of nitroglycerin patches with that of three-times-daily isosorbide dinitrate: a double-blind study using dose titration

M. M. BASSAN* and S. ROGEL{dagger},

*The Jerusalem Heart Clinic of Kupat Holim, Jerusalem, Israel and The Kaiser Permanente Medical Center Bellflower.CA, U.S.A.

Received 19 June 1991; revised 9 January 1992; .

Correspondence Mayer Bassan, M.D., Kupat Holim, 12, Paran St, Jerusalem, Israel

Abstract

Eight men with stable angina, a positive treadmill test, and demonstrated responsiveness to chronic oral isosorbide dinitrate (ISDN) were studied after they had been taking effective doses of ISDN t.i.d.for at least 2 weeks. Exercise tests were performed every 1–2 h until 19.00 hours over one day after the 08.00 hours application of nitroglycerin patches in a previously titrated dose; on another day after the administration of ISDN capsules q5h; and on a third day after placebo patches and capsules.

The mean necessary effective patch dose was 125 cm2 (60–220 cm2). The mean exercise duration to angina rose from 271 to 480 s 1 h after nitroglycerin patches (P < 0·001). Nitroglycerin patches were superior to the placebo throughout the day, but in a declining degree — by 94 s at 19.00 hours (P < 0·05). ISDN q5h provided peaks of increased walking time to angina I h after each dose, but after 3 h exercise time was down to placebo levels. Furthermore, the peaks were of diminishing amplitude: 200 s at 09.00 hours, 150 s at 14.00 hours, but only 70 s at 19.00 hours. Thus, neither nitrate regimen provided continuous near-peak benefit throughout the 11 h period, although nitroglycerin patches had a significantly greater (P < 005) overall effect during the day.

Key Words: Nitroglycerin • nitroglycerin patches • isosorbide dinitrate • angina pectoris • exercise testing


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