Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
Effects of transdermal nitroglycerin in combination with an ACE inhibitor in patients with chronic stable angina pectoris
Chair of Internal Medicine, University of Brescia Brescia, Italy
*Cardiovascular Rehabilitation Fasano (Brescia), Italy
Internal Medicine Department Citta' della Pieve (Perugia), Italy
Received 7 December 1992; revised 17 May 1993; .
Correspondence Maria Lorenza Muiesan, Chair of Internal Medicine University of Brescia, c/o la Medicina generale-Spedali Civili, 25100 Brescia, Italy
Abstract
We have previously shown that transdermal nitroglycerin may induce an increase in the activity of the adrenergic and the renin-angiotensin-aldosterone systems (SRAA) in patients with chronic stable angina pectoris (SA); when the activation of these systems is more pronounced, the antianginal effect of this drug seems to be reduced. The aim of this study was to evaluate the antianginal efficacy of transdermal nitroglycerin administration (TTS-NG 10 mg. 24 h–1) in combination with an ACE inhibitor without sulphydryl groups (BNZ, benazepril 10 mg b.i.d.) in respect to placebo, or to TTS-NG or BNZ administered as monotherapy. Twenty-four patients (21M, 3F) were admitted to this multicentre, randomized, double-blind, latin square, placebo-controlled study. Patients received all the treatments (placebo, TTS-NG, BNZ and BNZ+ TTS-NG) each for one week; at the end of each week patients performed two exercise testi 2 and 22 h post-dosing. Two hours post-dosing, exercise duration at 1 mm ST depression was significantly increased in respect to placebo during TTS-NG (P<0.05) and TTS-NG+BNZ (P<0.05) treatments. Two hours post-dosing, exercise duration at peak exercise was also increased in respect to placebo during TTS-NG (P<0.05) ana TTS-NG+BNZ (P<0.05); 22 h post-dosing the increase in exercise duration was significant only during TTS-NG+BNZ treatment (P<0.05) in respect to placebo, but not during TTS-NG given alone. Rate-pressure product at 1 mm ST depression was significantly increased 2 h post-dosing during TTS-NG treatment (P<005).
In conclusion, these results suggest that ACE inhibitor administration given in combination with TTS-NG can induce a statistically significant increase in exercise duration in stable angina patients in respect of placebo, 22 h post-dosing. The clinical significance of this finding must be evaluated in further studies.
Key Words: Stable angina pectoris • ACE inhibitors • nitrates • exercise tolerance
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Hebert and J. Y. T. Lam Nitroglycerin rebound associated with vascular, rather than platelet, hypersensitivity J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2311 - 2316. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kurz, U. Hink, G. Nickenig, A. B. Borthayre, D. G. Harrison, and T. Munzel Evidence for a Causal Role of the Renin-Angiotensin System in Nitrate Tolerance Circulation, June 22, 1999; 99(24): 3181 - 3187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Watanabe, M. Kakihana, S. Ohtsuka, and Y. Sugishita Randomized, Double-Blind, Placebo-Controlled Study of Ascorbate on the Preventive Effect of Nitrate Tolerance in Patients With Congestive Heart Failure Circulation, March 10, 1998; 97(9): 886 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Parker and J. O. Parker Nitrate Therapy for Stable Angina Pectoris N. Engl. J. Med., February 19, 1998; 338(8): 520 - 531. [Full Text] [PDF]
|
|
|
|
|
|
H. Watanabe, M. Kakihana, S. Ohtsuka, and Y. Sugishita Randomized, Double-Blind, Placebo-Controlled Study of Supplemental Vitamin E on Attenuation of the Development of Nitrate Tolerance Circulation, October 21, 1997; 96(8): 2545 - 2550. [Abstract] [Full Text]
|
|
|
|
|
|
T. Munzel and E. Bassenge Long-term Angiotensin-Converting Enzyme Inhibition With High-Dose Enalapril Retards Nitrate Tolerance in Large Epicardial Arteries and Prevents Rebound Coronary Vasoconstriction In Vivo Circulation, June 1, 1996; 93(11): 2052 - 2058. [Abstract] [Full Text]
|
|