Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Transdermal nitroglycerin efficacy in patients with chronic stable angina pectoris as related to sympathetic and renin-angiotensin-aldosterone activity
Clinica Medica, University of Brescia Italy
*Centro di Riabilitazione Cardiologica di Fasano, Spedali Civili Brescia, Italy
Received 14 March 1990; revised 6 December 1990; .
Correspondence. Dr Maria Lorenza Muiesan, UOP Scienze Mediche. Universita' di Brescia, Spedali Civili, 25125 Brescia, Italy
Abstract
The aim of this study was to evaluate the acute effects of transdermal nitroglycerin on the sympathetic and renin-angiotensin-aldosterone systems activity, in a group of patients with stable exercise induced angina pectoris.
Eighteen outpatients (15M, 3F, age range 47–65 years) were included in this double-blind, randomized, crossover trial comparing the antianginal effects of a transdermal system delivering 20mg. day–1 of nitroglycerin to an identical placebo. Plasma renin activity, plasma aldosterone and catecholamine concentrations were measured in resting basal conditions and at 4.8.24, and 32 h post-dosing.
Patients were subdivided in two groups according to the increase in exercise duration after patch application greater than 30% (responders, n=8) and less or equal to 30% (non-responders, n=10) in respect to placebo.
In responders plasma norepinephrine was slightly increased during transdermal nitroglycerin administration in comparison to placebo while no change was observed in plasma adrenaline and aldosterone concentrations and in plasma renin activity.
In non-responders plasma norepinephrine levels significantly increased during nitroglycerin treatment in comparison with placebo. Multiple comparisons showed that this increase was significant at 4,8 and 24 h post-dosing. Plasma epinephrine and aldosterone concentrations and plasma renin activity were also increased after nitroglycerin administration.
In the population as a whole, a significant inverse correlation was found between the percent increase in exercise duration (active drug vs placebo) and the absolute values of plasma norepinephrine and aldosterone, 4 h post-dosing.
In conclusion, the results of this study show that transdermal nitroglycerin may induce an increase in the activity of adrenergic and renin-angiotensin-aldosterone systems in patients with stable exercise-induced angina pectoris. When activation of these systems is more pronounced, the antianginal effect of this treatment appears to be reduced.
Key Words: Stable angina pectoris • transdermal nitroglycerin • tolerance • catecholamines • renin • aldosterone
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