Open AccessSustained salutary effects of oral controlled‐release nitroglycerin on ventricular function in congestive heart failure
Author(s) -
Amsterdam E. A.,
Awan N. A.,
Demaria A. N.,
Miller R. R.,
Williams D. O.,
Mason D. T.
Publication year - 1979
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960020104
Subject(s) - medicine , heart failure , hemodynamics , cardiac index , vascular resistance , vasodilation , cardiac output , cardiology , blood pressure , heart rate , anesthesia
The hemodynamic effects of a controlled‐release preparation of original nitroglycerin (ONTG), 6.5 mg to 19.5 mg, were determined during a four hour period in 10 patients with left ventricular failure. After ONTG ingestion left ventricular filling pressure (LVFP) diminished in 20 min (23 to 17 mm Hg, p < 0.01), declined maximally within one hour (15 mm Hg, p < 0.001) and remained decreased (p < 0.02) throughout the four hours. For the entire group no significant alterations (p > 0.05) occurred in systolic blood pressure, heart rate, cardiac index (CI) and peripheral vascular resistance (PVR). However, two subgroups were identified relative to ONTG hemodynamic response. In the four patients in whom LVFP declined but remained substantially elevated (29 to 23 mm Hg, p < 0.05), CI rose (1.7 to 2.1 l/min/m 2 , p < 0.01) while PVR fell (2074 to 1571 dyne · s · cm ‐5 , p < 0.02). In contrast, in the six patients with LVFP reductions to 12 mm Hg or less (18 to 10 mm Hg, p < 0.005), CI was unchanged (2.2, p > 0.05) without alteration of PVR (1799, p > 0.05). This investigation provides objective evidence of the salutary hemodynamic effects of ONTG and confirms adequate gastrointestinal absorption with attainment of pharmacologically active blood levels. Moreover, oral sustained‐release nitroglycerin is shown to possess long‐acting peripheral vasodilator actions of considerable value in the treatment of congestive heart failure.