This paper is only available as a PDF. To read, Please Download here.
Abstract
The hemodynamic effect of a large dose of nitroglycerin (NTG) (90 mg) given transdermally
using a reservoir system was studied in 10 patients with severe, long-standing congestive
heart failure. Serial hemodynamic measurements over 24 hours revealed a mild decrease
in mean pulmonary artery wedge pressure. However, the change from baseline was significant
only at 2 hours (19 ± 9 vs 27 ± 6 mm Hg). Mean right atrial pressure fell 1 hour after
initiation of therapy, from 12 ± 7 to 8 ± 5 mm Hg. However, the change from control
was not statistically significant. No significant changes were noted in heart rate,
mean blood pressure, cardiac index, and systemic and pulmonary vascular resistance.
Individual analysis of the effect of transdermal NTG on pulmonary artery wedge pressure
demonstrated at 20% or greater reduction in 8 of 10 patients. However, persistent
effect (longer than 8 hours) was seen in only 4 patients. Removal of NTG patches at
24 hours did not result in hemodynamic rebound. Serum catecholamine levels and renin
concentration did not change 2 hours and 24 hours after initiation of NTG therapy
or after removal of NTG patches. Thus, a large dose (90 mg) of transdermal NTG using
a reservoir system results in mild and mostly statistically insignificant hemodynamic
effect in patients with chronic severe congestive heart failure. Although a reduction
in pulmonary artery wedge pressure is seen in most patients, rapid attenuation of
this response is found in many patients and the effect only rarely lasts for 24 hours.
The lack of hemodynamic rebound after discontinuation of therapy in addition to the
absence of changes in serum catecholamine levels and renin concentration suggest that
hemodynamic attenuation is not a result of activation of vasoconstrictive mechanisms
during continuous NTG therapy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Glyceryl trinitrate (nitroglycerin) ointment and isosorbide dinitrate: a review of their pharmacological properties and therapeutic use.Drugs. 1982; 23: 165-194
- Hemodynamic effects of orally administered isosorbide dinitrate in patients with congestive heart failure.Circulation. 1974; 50: 1020-1024
- Improvement in supine bicycle exercise performance in refractory congestive heart failure after isosorbide dinitrate: radionuclide and hemodynamic evaluation of acute effects.Am J Cardiol. 1982; 49: 133-140
- Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure.Circulation. 1983; 67: 817-822
- Human pharmacological studies of a new transdermal system containing nitroglycerin.Eur J Clin Pharmacol. 1982; 22: 473-480
- Cutaneous administration of nitroglycerin: a review.Pharmacotherapy. 1983; 3: 149-156
- Pharmaceutical considerations of transdermal nitroglycerin delivery: the various approaches.Am Heart J. 1984; 108: 207-216
- Rationale for rate-controlled drug delivery of cardiovascular drugs by the transdermal route.Am Heart J. 1984; 108: 196-200
- Acute hemodynamic effect of oral nifedipine in severe chronic congestive heart failure.Am J Cardiol. 1983; 52: 1041-1045
- Cardiac output by thermodilution technique, effect of injectates volume and temperature on accuracy and reproducibility in the critically ill patients.Chest. 1983; 84: 418-422
- Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine, and dopamine.Life Sci. 1977; 21: 625-636
- Characterization of inactive renin from human kidney and plasma evidence of renal source of circulating inactive renin.J Clin Invest. 1983; 71: 506-517
- Lack of hemodynamic effect of high dose transdermal nitroglycerin in severe heart failure.Circulation. 1984; 70 (abstr): II-114
- Statistical Principles in Experimental Design.in: McGraw-Hill, New York1971: 191-195
- Dose dependence of the hemodynamic responses to nitrate therapy in patients with refractory congestive heart failure.Clin Res. 1979; 27 (abstr): 192A
- Antianginal effects of nitroglycerin patches.Am J Cardiol. 1984; 54: 1-7
- Therapeutic efficacy of a new transdermal system containing nitroglycerin in patients with anginal pectoris.Eur J Clin Pharmacol. 1982; 22: 481-485
- Pharmacokinetic-hemodynamic studies of nitroglycerin ointment in congestive heart failure.Am J Cardiol. 1980; 46: 670-676
- Sustained beneficial hemodynamic responses to large doses of transdermal nitroglycerin in congestive heart failure and comparison with intravenous nitroglycerin.Am J Cardiol. 1984; 54: 120-125
- Hemodynamic and hormonal response to transdermal nitroglycerin in normal subjects and in patients with congestive heart failure.JACC. 1983; 2: 872-878
- Transdermal isosorbide dinitrate in anginal pectoris: effect of acute and sustained therapy.Am J Cardiol. 1984; 54: 8-13
- Transdermal nitroglycerin in heart failure.Circulation. 1984; 70 (abstr): II-114
- Rapid attenuation of hemodynamic efficacy of continuous transcutaneous nitroglycerin in severe heart failure: lack of cross-tolerance of isosorbide dinitrate.Circulation. 1984; 70 (abstr): II-114
- The neurohumoral axis in congestive heart failure.Ann Intern Med. 1984; 101: 370-377
- Vasodilator therapy in heart failure: limited by activation of vasoconstrictor mechanisms?.Circulation. 1980; 62 (abstr): III-259
- Mechanisms and implications of vasodilator tolerance in the treatment of congestive heart failure.Am J Med. 1981; 71: 89-99
Article Info
Publication History
Accepted:
April 22,
1985
Received in revised form:
April 16,
1985
Received:
February 15,
1985
Identification
Copyright
© 1985 Published by Elsevier Inc.