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- W1968442373 abstract "Transdermal systems for delivery of nitroglycerin have been shown to provide sustained blood levels of the drug for at least 24 hours. Investigations of hemodynamic effects of transdermal nitroglycerin in patients with heart failure have demonstrated a transient reduction in pressure lasting less than the expected 24 hours. These findings could be due to the development of circulatory tolerance to the vasodilatory effects of nitroglycerin or to insufficient drug dosing. In the present study, we compared the hemodynamic effects of the first and the second doses of high dose (120 mg) transdermal nitroglycerin given 24 hours apart in 11 responders (≥20% reduction in mean pulmonary artery wedge pressure lasting ≥2 hours). Initiation of nitroglycerin therapy resulted in a significant reduction in mean right atrial pressure lasting for 14 hours and in a reduction in mean pulmonary artery and mean pulmonary artery wedge pressures lasting 24 hours. After administration of the second dose, mean right atrial pressure at 2 hours (9 ± 5 versus 7 ± 4 mm Hg), 4 hours (8 ± 5 versus 6 ± 4 mm Hg) and 8 hours (8 ± 5 versus 6 ± 3 mm Hg) was higher than after the first dose (p < 0.05). Both mean pulmonary artery and mean pulmonary artery wedge pressures were significantly higher after the second nitroglycerin dose. Mean pulmonary artery pressure after the second dose was 32 ± 8 versus 28 ± 7 mm Hg at 2 hours (p < 0.05), 32 ± 7 versus 27 ± 7 mm Hg at 4 hours (p < 0.01), 33 ± 10 versus 27 ± 6 mm Hg at 6 hours (p < 0.05) and 31 ± 8 versus 26 ± 7 mm Hg at 8 hours (p < 0.05). Mean pulmonary artery wedge pressure was 22 ± 7 versus 17 ± 7 mm Hg at 2 hours (p < 0.01), 21 ± 8 versus 16 ± 6 mm Hg at 4 hours (p < 0.01), 19 ± 8 versus 16 ± 7 mm Hg at 6 hours (p < 0.05) and 20 ± 9 versus 15 ± 6 mm Hg at 8 hours (p < 0.01). It is concluded that in patients with chronic congestive heart failure, the initial hemodynamic changes seen after the administration of high dose transdermal nitroglycerin are significantly attenuated within hours of the first dose. These findings suggest that circulatory tolerance to the effect of sustained nitroglycerin therapy develops early and should be taken into consideration when transdermal nitroglycerin is used in short- and long-term therapy of chronic heart failure." @default.
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- W1968442373 date "1987-04-01" @default.
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- W1968442373 title "Early tolerance to hemodynamic effects of high dose transdermal nitroglycerin in responders with severe chronic heart failure" @default.
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- W1968442373 doi "https://doi.org/10.1016/s0735-1097(87)80242-5" @default.
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