The antianginal efficacy of isosorbide dinitrate therapy is maintained during diuretic treatment

Abstract

Patients using a diuretic with isosorbide dinitrate maintain an increased anginal threshold and total exercise time compared with placebo. Weight change is inversely related to exercise duration, and this result is consistent with fluid retention restoring cardiac preload during nitrate use. The increased anginal threshold during concurrent isosorbide dinitrate and diuretic use may be attributable to maintenance of the organic nitrate-induced reductions in cardiac preload.

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults

“…692 Both nitrates and beta blockers can improve anginal symptoms and may produce hemodynamic and clinical benefits in patients with reduced LVEF, and thus, they are preferred if these conditions coexist. 158,162,164,693,694 Yet, the combination of the 2 drugs may produce little improvement in anginal pain unless fluid retention is adequately controlled with diuretics. It is therefore noteworthy that the decrease in ventricular volume and pressures produced by diuretics may exert independent antianginal effects.…”

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

“…Both nitrates and beta-blockers can improve anginal symptoms and may produce hemodynamic and clinical benefits in patients with reduced LVEF, and thus, they are preferred if these conditions coexist (255,260,262,578,579). Yet, the combination of the 2 drugs may produce little improvement in anginal pain unless fluid retention is adequately controlled with diuretics.…”

Nitrate Therapy for Stable Angina Pectoris

“…Attempts to prevent the development of tolerance with diuretic therapy have been carried out, with conflicting results. 57,[81][82][83] We recently reported that hydrochlorothiazide had no effect on the development of tolerance to the antianginal effects of transdermal nitroglycerin in a double-blind, randomized trial. 83…”