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Acute Drug Testing with Nitrates: Angina Relief during Treadmill Exercise
Author(s) -
Fletcher Gerald F.,
Alimurung Benjamin,
Watt Edward
Publication year - 1977
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1977.tb00642.x
Subject(s) - medicine , angina , isosorbide dinitrate , placebo , treadmill , significant difference , anesthesia , cardiology , physical therapy , myocardial infarction , alternative medicine , pathology
To evaluate the effect of sublingual nitroglycerin (N) and chewable isosorbide dinitrate (I) in patients with angina pectoris, 12 subjects underwent treadmill exercise to the point of onset of angina. At that juncture, N or I or placebo (P) was administered and walking was continued until moderately severe angina recurred. For those patients who completed the initial 10‐minute exercise period, testing was repeated until moderately severe angina recurred or until a total test time of three hours elapsed. Retesting ensured that each patient was tested separately with N, I and P within a two‐week period. Within the I group, four patients experienced the onset of angina relief (AR) at 10 minutes (′) 6 seconds (″) ± 3′ 4″ with a mean recurrence time (RT) of 154′ 3″ ± 4′ 27″ (P ≤ 0.05), for a significant difference. Within the N group, six patients had AR of 8′ 3″ ± 1′ 1″ with an RT of 49′ 39″ ± 1′ 15″ (P ≤ 0.01), for a significant effect. Within the P group, only one patient experienced AR. For all other patients in each group, testing was terminated because of moderately severe angina in the 5–8′ period of the first test. In comparing subgroups for RT during I therapy (4 patients) versus N therapy (6 patients), a significant difference was noted (154′ 3″ ± 27″ versus 49′ 39″ ± 1′ 15″) (P < 0.05). The data suggest a possible benefit of I in selected patients. The effect may last as long as three to four hours. There is also an enhanced benefit of N with the patient in the upright position. This effect may last as long as 40–50′. Treadmill testing is recommended with nitrate administration to determine which drug (I or N) is the more suitable for the specific patient.