Open AccessEfficacy of Controlled-Release Isosorbide-5-Mononitrate as Adjunctive Treatment to β-Blocking Agents in Patients with Stable Angina Pectoris
Author(s) -
Jesper Hastrup Svendsen,
Jan Aldershvile,
Ulrik Abildgaard,
Ole Amtorp
Publication year - 1989
Publication title -
journal of cardiovascular pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.762
H-Index - 100
eISSN - 1533-4023
pISSN - 0160-2446
DOI - 10.1097/00005344-198909000-00002
Subject(s) - isosorbide dinitrate , medicine , placebo , angina , isosorbide mononitrate , regimen , adjunctive treatment , anesthesia , randomized controlled trial , cardiology , myocardial infarction , alternative medicine , pathology
Twenty-four patients with severe stable angina pectoris were included in a randomized, double-blind, placebo-controlled, cross-over study to assess the efficacy of a controlled-release preparation of isosorbide-5-mononitrate (ISMN-CR) 60 mg once daily or twice daily as adjunctive treatment to a beta blocker. In bicycle ergometer exercise tests performed 4 h after study drug intake, total exercise time and time until 1-mm ST-depression increased significantly during both regimens as compared with placebo (p less than 0.05). However, only the 60-mg once-daily regimen was significantly better than placebo with regard to time until angina pectoris. The results indicate that ISMN-CR 60 mg once daily is effective as adjunctive to beta-blocker treatment, and nitrate tolerance appeared to develop during the twice-daily regimen. In 10 of the patients, the effect of additional sublingual nitroglycerin (NTG) was studied. Exercise time after NTG remained remarkably constant throughout all study periods. Exercise time was significantly prolonged after additional NTG and independent of the dose level of ISMN-CR. This indicates that cross-tolerance to NTG was not induced during sustained treatment with ISMN-CR.