Efficacy and safety of extended-release isosorbide mononitrate for stable effort angina pectoris

Chrysant, Steven G.; Glasser, Stephen P.; Bittar, Neville; Shahidi, F.Eden; Danisa, Kola; Ibrahim, Radwin; Watts, Lester E.; Garutti, Ronald; Ferraresi, Rudolfo; Casareto, Roberto

doi:10.1016/0002-9149(93)90292-k

Cited by 105 publications

(49 citation statements)

References 16 publications

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“…Nitrates are organic products that, in the vessel wall, undergo enzymatic denitrification by mitochondrial aldehyde dehydrogenase, producing vasoactive nitric oxide, which causes vasodilatation 19 . At low doses, nitrates are predominantly venodilators and thus reduce preload and venous return to the heart with reductions in ventricular volume and myocardial wall tension, leading to a decrease in myocardial oxygen demand.…”

Section: Drug Therapymentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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Chronic stable angina pectoris is the most prevalent symptomatic manifestation of ischaemic heart disease, and its management is a priority (BOX 1). Current clinical guidelines recommend antianginal therapy to control symptoms, before considering coronary artery revasculariza tion [1][2][3][4] . However, revascularization by either percutaneous coronary angioplasty or CABG surgery is indicated in patients who have significant artery steno sis (50% left main narrowing or proximal three-vessel disease) to reduce myocardial ischaemia and its adverse clinical manifestation. Antianginal agents are approved by documenting that they improve total exercise duration, together with a reduction in daily frequency of chronic stable angina compared with placebo and/or equivalence to an active comparator. Cardiovascular outcomes, although highly advocated, are not a pre requisite for regulatory approval. None of the antianginal drugs has been proved to reduce cardiovascular mortality or the rate of myocardial infarction. When patients are optimally treated, mortality for chronic stable angina is low, which might explain why all trials designed to improve prognosis have been negative. Guidelines recom mend a first-choice and a second-choice approach, based more on tradition and expert opinion, rather than evidence. This categorical approach has been questioned in the past couple of years 5-8 . Newer antianginal drugs, which are classified as second choice, have more evidence-based clinical data that are more contemporary to support their use than is available for the traditional first-choice drugs. Equally, the often-needed combin ation of double or triple therapy is based on expert opinion and not related to the underlying pathophysio logy. What constitutes optimal antianginal treatment, therefore, varies considerably between countries, and the majority of doctors treat their patients according to their own preconceptions.A group of experts with experience and interest in chronic stable angina met at the University of Ferrara, Italy, to discuss an individualized approach to medical treatment of chronic stable angina, on the basis E X P E RT C O N S E N S U S D O C U M E N TA 'diamond' approach to personalized treatment of angina Abstract | In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for tr...

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Section: Drug Therapymentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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“…Толерантность к нитратам, как одну из потенциальных проблем, можно предотвратить путем изменения дозирования и времени приема, а также путем использования препаратов с медлен-ным высвобождением [285,286]. Таким образом, только формы с быстрым высвобождением, с прие-мом 2 раза в сутки, либо очень высокие дозы монони-трата, также с приемом 2 раза в сутки, обеспечивают стойкий антиангинальный эффект.…”

Section: препаратыunclassified

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Montalescot

Sechtem²,

Achenbach³

et al. 2014

Russ J Cardiol

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“…Intermittent transdermal nitroglycerin therapy also has adverse effects on performance on treadmill exercise tests during the period of withdrawal from nitrates. Adverse effects on exercise tolerance have not been reported in studies of other long-acting nitrates given once daily or in eccentric dosing regimens (55,56). The mechanism of adverse responses during the nitrate-free interval of intermittent transdermal nitroglycerin therapy is unclear, but they may be due to a heightened sensitivity to vasoconstrictors.…”

Section: Benefits Of Eccentric Dosing Of Nitratesmentioning

confidence: 99%

“…No information is available concerning such adverse effects during eccentric dosing with isosorbide nitrate. Isosorbide mononitrate has not been reported to cause either rebound ischemia or adverse effects on exercise performance (55,56,58).…”

Section: Benefits Of Eccentric Dosing Of Nitratesmentioning

confidence: 99%