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PubMed1982

[5-isosorbide mononitrate at rest and on exercise in coronary heart disease: acute and long-term effect].

Haemodynamic effects of 5-isosorbide mononitrate (5-ISMN) were studied at rest and on exercise in 31 patients with angiographically confirmed coronary heart disease. A decrease in arterial blood pressure and mean pulmonary artery pressure without significant change in heart rate, cardiac output and stroke volume occurred both at rest and on exercise after 20 mg of 5-ISMN to 12 patients. Administration of 50 mg 5-ISMN to 19 patients achieved greater decrease in mean pulmonary artery pressure; cardiac output and stroke volume were highly significantly reduced at rest, while on exercise both cardiac output and stroke volume remained unchanged. Ten patients, in whom after a single dose of 50 mg 5-ISMN the mean pulmonary artery pressure at rest and on exercise had decreased 28% and 45%, respectively, with a definite rise in exercise tolerance, repeat acute administration of a single dose of 50 kmg 5-ISMN produced a fall in mean pulmonary artery pressure at rest by 20% after 50 mg three times daily for four weeks. On exercise the fall was only 14% below the control levels before treatment. In addition, exercise tolerance was reduced. These results indicate that acute administration of 5-ISMN at rest and on exercise decreases cardiac work load. But on chronic administration of high doses, tolerance to the drug may develop.

Adult↗
PubMed1980

[Fendiline and isosorbide dinitrate in coronary heart disease (author's transl)].

In a randomized cross-over double-blind study of 30 out-patients with true angina the efficacy of fendiline and isosorbide dinitrate (ISDN) was compared. In randomized order the patients daily took either 3 X 50 mg fendiline or 2 X 20 mg ISDN (plus 1 placebo tablet). Each treatment period lasted for six weeks. Ergometric tests were performed at the onset of the study and at intervals of three weeks. The main criterion for the efficacy of the treatment was a change in S-T segment (at 0.06 s after the QRS). With either drug there occurred a statistically significant reduction in S-T depression and in the frequency of anginal attacks during the first treatment period. But there was a difference between the two drugs: Whereas with ISDN a marked reduction in S-T segment depression was observed after three weeks, this effect slightly receded in the second part of the treatment period, while with fendiline the reduction in S-T depression continued over the entire treatment period. There was no significant difference between the two drugs as to side-effects or tolerance.

Adult↗
PubMed2003

Randomized, double-blind, placebo-controlled long-term study of isosorbide-5-mononitrate therapy in patients with left ventricular dysfunction after acute myocardial infarction.

BACKGROUND: Nitrates are often administrated with a variety of other pharmacologic agents in the management of chronic heart failure (CHF). However, limited information is available concerning the long-term effects in patients with evidence of left ventricular (LV) dysfunction after acute myocardial infarction (AMI) already treated with standard heart failure therapy. METHODS: In a randomized, double-blind, placebo-controlled trial, we evaluated the effects of a 60 mg dose of isosorbide-5-mononitrate (IS-5-MN) given daily for 11 months to 47 patients with clinical or echocardiographic evidence of left ventricular dysfunction after acute myocardial infarction. Forty-five patients received a placebo. RESULTS: Invasive hemodynamic measurements did not show any difference between the treatment regimens. Overall changes in echocardiographic measurements were not significantly different between IS-5-MN therapy and the placebo groups. However, in a prespecified subgroup with left ventricular ejection fraction < or =40% at baseline, IS-5-MN therapy resulted in a lesser increase of end-diastolic volume index than the placebo (P =.047). IS-5-MN significantly reduced the serum concentration of atrial natriuretic peptide (mean 20.0 pmol/L, 95% CI 7.7-32.3, P =.002), whereas the placebo did not (P =.041 for the difference between the groups). The proportion of patients taking diuretics was significantly reduced in the IS-5-MN group, from 30 of 44 to 20 of 44 (P =.02), but not with placebo, which remained at 27 of 43 (P = 1.0, with P =.048 for the difference between the regimens). CONCLUSIONS: Oral, long-term IS-5-MN therapy resulted in lower atrial natriuretic peptide levels and reduced the need for additional diuretics. Less LV dilatation was observed in patients with more severe LV dysfunction at baseline.

Aged↗
PubMedDate not supplied

Sustained reduction of exercise perfusion defect extent and severity with isosorbide mononitrate (Imdur) as demonstrated by means of technetium 99m sestamibi.

BACKGROUND: The impact of long-acting nitrates on the extent and severity of stress-induced myocardial ischemia is not well described, especially after long-term treatment. METHODS: Forty patients with chronic stable angina and reversible ischemia on an exercise stress myocardial perfusion single photon emission computed tomography (ex-SPECT) were prospectively studied in a 6-week period. At baseline, rest thallium-201/exercise stress technetium 99m sestamibi SPECT was performed, followed by treatment with extended-release isosorbide 5-mononitrate (5-ISMN, Imdur). Follow-up ex-SPECT was performed 5 days and 6 weeks after the initiation of therapy with extended-release 5-ISMN. The exercise treadmill testing (ETT) protocol and exercise duration of the follow-up studies were the same as that of the baseline ETT. Defect extent and severity were analyzed both by means of an automated quantitative method, with CEqual software, and visually, with a 20-segment scoring system (which was also used to derive a summed stress score [SSS]). RESULTS: In the 6-week study period, significant reductions occurred in both the extent and the severity of exercise-induced ischemia by means of quantitative SPECT (13.8% [P<.0003] and 12.7% [P<.0003], respectively). There was no significant change in these variables between stages 2 (day 5) and 3 (6 weeks), indicating no development of tolerance to the nitrate effect. Similar reductions were noted by means of the visual analysis (SSS reduction of 13.0% [P<.002]) in the entire study period. CONCLUSIONS: Patients with chronic-stable-angina treated with a long-acting nitrate demonstrate improvement in myocardial perfusion defect extent and severity in an extended period by means of both visual and quantitative analysis of sequential exercise testing to the same rate-pressure product end point.

Aged↗
PubMedDate not supplied

Preparation, characterization and in vitro drug release of isosorbide dinitrate microspheres.

Microspheres of isosorbide dinitrate (ISDN) were prepared using the emulsification/solvent evaporation method. The impacts of different factors such as stirring rate, concentration of ethyl cellulose (EC) as matrix polymer, poly vinyl chloride (PVA) as stabiliser and ISDN on the characteristics of the microspheres were investigated. The morphology of microspheres was studied using optical and scanning electron microscopy and it was shown that microspheres had a spherical shape and smooth surface. The particle size distribution of microspheres, analysed by a sieving method, was affected by stirring rate and concentrations of EC, PVA and ISDN. Larger microspheres showed greater drug loading and smaller microspheres showed a faster drug release. The in vitro drug release from microspheres was predictable and reproducible, conforming to the Higuchi model of release kinetics.

Cellulose↗
PubMed2006

Preparation and control-release kinetics of isosorbide dinitrate microspheres.

Microcapsules for sustained release of poorly soluble isosorbide dinitrate (ISDN) were prepared based on ethylcellulose (EC) and/or blended with appropriate amounts of relatively hydrophilic hydroxypropyl cellulose (HPC) as matrix materials using the oil-in-oil emulsion evaporation method. The microspheres studied had three-mode sizes (100-150, 250-300 and 400-450 microm) and four polymer compositions (1, 0.833, 0.67 and 0.5 weight fraction EC). The microspheres were observed to contain essentially no drug crystalline domain and were of a porous morphology. The cumulative amounts of ISDN releasing from the microspheres as functions of mode fractions size and polymer compositions were measured in vitro. It was observed that the microspheres' size influenced the release behaviour of drug more obviously than the polymer composition. The smaller size and the higher hydrophilic HPC content show the faster release rate of drug and the smaller amount of drug residue. The kinetics of drug release depends on the size and polymer composition. The microspheres with 100-150 microm, of all polymer compositions, present one-stage diffusion kinetic with a lag period for drug release. On the other hand, the microspheres with the other two sizes exhibit two-stage diffusion kinetic with a lag period. According to the kinetic model, the microspheres obtained are surmised to have a core-shell like drug concentration distribution and/or a core-shell morphology.

Cellulose↗
PubMed1998

Cardiovascular effects of dietary salts and isosorbide-5-mononitrate in spontaneously hypertensive rats.

The influence of isosorbide-5-mononitrate (IS-5-MN) on the cardiovascular effects of high dietary salt intake (NaCl, 6.6% of dry weight of food) and that of a potassium, magnesium and l-lysine-enriched salt alternative (Pansalt 10.5%, producing a 6.6% content of NaCl) was studied in spontaneously hypertensive rats in an 8-week experiment. Common salt produced a marked rise in blood pressure and induced cardiac and renal hypertrophy, while the salt alternative, although containing the same amount of NaCl, neither increased blood pressure nor caused any significant cardiac hypertrophy. IS-5-MN treatment at a daily dose of approximately 60-70 mg/kg (mixed with food) attenuated the rise in blood pressure induced by common salt, but did not prevent the cardiac or renal hypertrophy. IS-5-MN did not offer any additional benefit to the use of the salt alternative diet alone in treatment of high blood pressure. Mesenteric arterial responses in vitro were examined at the end of the study. IS-5-MN treatment during the moderately low-salt (NaCl 0.7%) control diet tended to decrease the contractile response to noradrenaline and increase the relaxation to acetylcholine. Common salt, but not the salt alternative, induced a 50% increase in the 24-h urinary excretion of cyclic GMP. Both salt supplements induced an 8-9-fold increase in the excretion of calcium, and about a 2-fold increase in the excretion of phosphorus. Common salt also increased the excretion of magnesium by 50%. IS-5-MN treatment had no significant effect on the excretion of the mineral elements. Our findings show that increased intake of potassium and magnesium reduces the harmful effects of common salt. Pressure-independent mechanisms are involved in salt-induced left ventricular and renal hypertrophy, since they remained unaffected despite the prevention of the salt-induced rise in blood pressure by IS-5-MN treatment.

Animals↗
PubMedDate not supplied

Effects of vehicles and pressure sensitive adhesives on the penetration of isosorbide dinitrate across the hairless mouse skin.

The effects of various vehicles and adhesives on the percutaneous absorption of isosorbide dinitrate (ISDN) were evaluated. Lauroglycol FCC showed the highest flux among vehicles tested. The flux of ISDN from silicone and acrylic adhesive matrices was found to be higher than that from other types of adhesive matrices. No statistically significant relationship between the flux from acrylic PSA and the flux from a solution formulation was observed. A highly cross-linked acrylic adhesive gave higher permeation rates than the other acrylic adhesives examined. N-decylmethyl sulfoxide showed the highest enhancing effect on the flux of ISDN from acrylic adhesive. The relationship between the HLB values of vehicles and the measured flux showed a decrease of flux at HLB values greater than 12.

Adhesives↗
PubMed1992

Vasodilator properties of nitroglycerin and isosorbide dinitrate during cardiopulmonary bypass.

In a placebo-controlled trial, we have studied the vasodilator properties of bolus doses of nitroglycerin (TNG) and isosorbide dinitrate (ISDN) in 32 patients during cardiopulmonary bypass with a constant pump flow. Blood volume of the venous reservoir and mean arterial pressure were recorded for 10 min after drug administration to detect changes in venous capacitance and arteriolar resistance, respectively. The venous capacitance-increasing effects of TNG 200 micrograms and ISDN 1,600 micrograms were initially identical and significant at 2 and 3 min after the bolus. Thereafter, the effect of TNG began to decline, while that of ISDN remained significant until the end of the study. TNG 200 micrograms decreased arterial pressure slightly more than ISDN 1,600 micrograms, but the effect of both drugs lasted for only 1-2 min. TNG and ISDN were equipotent in increasing venous capacitance when administered in a bolus dose ratio of 1:8 during CPB, but the venodilator effect of ISDN lasted longer than that of TNG. The duration of the arteriolar dilator effect was very short with both drugs.

Adult↗
PubMed1993

Pulmonary vascular effects of trinitroglycerin and isosorbide dinitrate after cardiopulmonary bypass.

We have compared the systemic and right ventricular haemodynamic effects of trinitroglycerin (TNG) and isosorbide dinitrate (ISDN) in patients recovering from coronary artery bypass grafting. Each of the 16 patients was given increasing i.v. doses of the two nitrates in a random order and double blind fashion until the target of a 25% decrease in mean pulmonary artery pressure (MPAP) was achieved. Total doses of TNG 9 (6-12) micrograms kg-1 (mean, 95% confidence interval) and ISDN 148 (76-220) micrograms kg-1 were given during infusions of 22 (18-25) min and 34 (28-41) min duration, respectively. The target decrease in MPAP was produced with infusion rates of TNG 0.5 (0.4-0.7) micrograms kg-1 min-1 and ISDN 5.8 (4.1-7.5) micrograms kg-1 min-1. These doses produced similar acute decreases in MPAP and similar effects on pulmonary and systemic vascular resistances and systemic and right ventricular haemodynamic variables. We conclude that TNG is more than 10 times as potent as ISDN in its acute haemodynamic effects in cardiac surgical patients in the immediate postoperative period. Both nitrates have relatively greater effects on the pulmonary than the systemic vasculature.

Adult↗
PubMed1991

Differences in the antiischaemic effects of molsidomine and isosorbide dinitrate (ISDN) during acute and short-term administration in stable angina pectoris.

The acute and short-term effects of treatment with 10 consecutive doses of isosorbide dinitrate 40 mg t.i.d. and molsidomine 8 mg t.i.d. in slow release formulations were investigated in 10 patients with angiographically documented coronary artery disease and stable angina pectoris according to a randomized, double-blind, double-dummy, cross-over study design using conventional symptom-limited exercise testing. Acute exercise testing 3 h following the first dose of ISDN and molsidomine showed a significant reduction of maximal ST segment depression and of the area above the ST segments. Time to occurrence of 0.1 mV ST segment depression, exercise duration, time to onset of angina and exercise tolerance increased significantly. On the fourth treatment day with ISDN and molsidomine an attenuation of these antiischaemic effects was seen. The mean effects on ST segment depression, area above ST segments, time to occurrence of 0.1 mV ST segment depression, exercise duration, time to onset of angina and exercise tolerance were reduced by 40%, 44%, 47%, 58%, 54% and 65%, respectively, in patients administered ISDN and by 33%, 48%, 58%, 59%, 45% and 60% in those given molsidomine. Thus, following sustained short-term therapy the antiischaemic effects of both drugs seem to be attenuated. In this report no marked differences were found between ISDN and molsidomine.

Angina Pectoris↗
PubMed1988

Isosorbide-5-mononitrate and nifedipine can reduce ischaemic ST-segment changes during Holter monitoring in patients with spontaneous angina pectoris.

Ambulatory electrocardiographic monitoring is as yet the only method to document ischaemia occurring in patients with coronary artery disease during their normal daily activities. We conducted a controlled double-blind trial comparing the effects of isosorbide-5-mononitrate (IS-5-MN) 3 X 20 mg, sustained release IS-5-MN 50 mg once daily and sustained release nifedipine 3 X 20 mg in patients with documented coronary heart disease and transient ischaemic episodes. 20 patients were included, 15 finished the four-week study period. Two developed unstable angina, one headache, one thyreotoxicosis, one a hypertensive crisis and were thus withdrawn. On dual-channel FM recorded ECG ischaemic episodes were counted when ST-deviation was more than 1 mm for more than 1 min. 70% of the ischaemic episodes were asymptomatic. Patients received IS-5-MN and nifedipine in 4 weekly periods in random order. At the end of each weekly period, ambulatory monitoring was repeated and showed reduction of episodes by 68% and 68% for IS-5-MN weeks and 56% and 60% for nifedipine weeks all P less than 0.05 vs. pretreatment. The reduction in number and duration of episodes was similar for painful and painless episodes. Individual responses were very variable and in all treatment periods only around half of the patients became completely free of ischaemic episodes. Two of the 15 patients did not respond to either way of treatment. In conclusion--treatment effects for a group of patients with transient--predominantly silent--ischaemia can be documented with ambulatory electrocardiographic monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1988

Slow-release isosorbide-5-mononitrate--a new once daily therapeutic modality for angina pectoris.

The acute and chronic efficacy of slow-release isosorbide-5-mononitrate (IS-5-MN) in the form of Elantan long capsules (50 mg) and the tolerability to this agent were evaluated in an open study of 45 patients with chronic stable angina pectoris, treated for one year. After 3 days of replacement of previous antianginal treatment with placebo, an Elantan long capsule (50 mg) was given once daily in the morning. Exercise test was performed 6 hours after ingestion of the capsule, on placebo (after wash-out of 3 days), in the first day of treatment, and after 3 and 6 months of treatment as well as 6 and 24 hours after 12 months of treatment compared to the exercise test at the same time after discontinuation of treatment (three days on placebo). At comparable work load the drug was associated with a 26.6% reduction in ST-segment depression after 6 hours of acute treatment, 46.7% after 3 months of treatment, 52.2% after 6 months, and 66% at the end of treatment (12 months) (P less than 0.001). Even 24 hours after intake of the last capsule of Elantan long the ST-segment reduction was still 49.5%. Exercise test 24 hours after ingestion of the drug revealed that the effect still exists. In the post-treatment placebo period all values returned to pretreatment levels. The sublingual nitroglycerin consumption was reduced by 90% and the frequency of anginal attacks was reduced from 19 +/- 15 to 1.1 +/- 4.2 weekly (P less than 0.001). The drug was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1988

Cooling down unstable angina with high dosage of isosorbide dinitrate (ISDN) continuously infused.

The aim of this study was to explore the capability of isosorbide dinitrate (ISDN) infusion to quench the 'hot phase' of unstable angina, a real cardiological emergency. Fifteen patients consecutively admitted to CCU because of angina at rest, with at least 4 ischaemic attacks per day, resistant to the usual therapy with oral and/or topical nitrates and calcium-antagonists, were included in the study. During ischaemia the electrocardiogram showed ST-segment elevation in 7 patients, ST-segment depression in 4, an alternation of ST-segment elevation and depression in 3 and pseudonormalization of a basally negative T wave in 1 patient. History of exertional angina with variable degrees of effort was reported in 6 patients and 9 had an old myocardial infarction. Coronary arteriography performed in 10 patients showed a significant stenosis of 1, 2 and 3 vessels in 5, 2 and 3 patients, respectively. ISDN infusion was started at 1.0 mg h-1, and was increased stepwise when persistence of ischaemic episodes had to be faced. The mean dosage infused was 3.5 mg h-1 (range 1.00-12). The mean duration of intravenous therapy was 8.3 days (range 2-25). Eleven of the 15 patients (73%) showed an effective decrease in the number of ischaemic episodes during ISDN infusion, as assessed by regression and variance analysis. After discharge (mean follow-up 59 months, range 2-96), 7 patients were free from ischaemic attacks, 3 underwent coronary by-pass surgery, 2 complained of some attacks and 3 died (2 because of sudden death three years after this study). In conclusion, ISDN infusion--individually tailored for dosage and duration--can be effective in 'cooling down' the storm of ischaemic episodes in unstable angina. An effective intravenous therapy with nitrates can represent, in some patients, a temporal remedy on the way to elective coronary bypass surgery and/or towards elective PTCA. Furthermore, in a sizeable number of patients with unstable angina, this approach can attain a complete abolishment of the ischaemic attacks.

Adult↗
PubMed1988

Control of perioperative hypertension during coronary artery surgery. A randomised double-blind study comparing isosorbide dinitrate and nitroglycerin.

A reduction in the causes of myocardial ischaemia remains of prime importance during coronary artery surgery. Hypertension with the ensuing increase in myocardial oxygen demand is a major factor in the aetiology of perioperative myocardial ischaemia. Nitroglycerin (NTG) has long been used beneficially to reduce myocardial oxygen demand by its effects on the systemic and peripheral vascular resistances. An alternative nitrate, isosorbide dinitrate (ISDN) is now available as an intravenous preparation, and may offer technical advantages, both due to its stability in solution and also its longer in vivo half-life. We designed and carried out a multi-centre study to compare and evaluate the efficacy of ISDN and NTG in the management of perioperative hypertension in 85 patients undergoing elective coronary artery surgery. A total of 288 events in which the systolic blood pressure (SBP) exceeded a predetermined trigger value were observed. ISDN was successful in treating hypertension in 63% of the events, whereas NTG had an 83% success. The SBP was significantly lowered after treatment with either ISDN, 155 mmHg to 138 mmHg, or NTG, 160 mmHg to 130 mmHg. The mean successful dose rate for ISDN was 6.5 micrograms kg-1 min-1, whereas for NTG this was 3.8 micrograms kg-1 min-1. In the ISDN group less events took place possibly due to the longer duration of this drug. In many previous studies NTG has been found to be effective in controlling hypertension; ISDN offers and alternative approach in reducing hypertension.

Coronary Artery Bypass↗
PubMed1988

Long-term reduction of pulmonary hypertension in interstitial lung fibrosis by isosorbide dinitrate.

The effect of isosorbide dinitrate (ID) on the development of pulmonary hypertension (PH) has been examined in 18 patients with idiopathic diffuse interstitial lung fibrosis (IDILF) during two years of treatment. All patients responded favourably to acutely administered ID by a decrease in pulmonary vascular resistance (PVR) by 38 +/- 13% and of the pulmonary arterial pressure (PAP) by 35 +/- 11%. Two years ID therapy led to sustained haemodynamic improvement in patients in whom blood gases were stable PAP was reduced from 38 +/- 5 to 30 +/- 6 mmHg and PVR from 483 +/- 197 to 364 +/- 175 dyne s cm-5. No haemodynamic changes were noted in the subjects with progressive hypoxaemia whereas steady deterioration of central haemodynamics was recorded in those patients who died during the follow-up. It is concluded that some patients with IDILF and PH may benefit from long-term ID treatment, but that the outcome of this treatment cannot be reliably predicted from the results of the initial first ID administration.

Adult↗
PubMed2006

A randomized clinical trial of the effects of isosorbide mononitrate on bone formation and resorption in post-menopausal women: a pilot study.

BACKGROUND: Nitric oxide (NO) stimulates bone formation and inhibits bone resorption in vitro. NO donors (nitrates) are inexpensive and widely available, but their value for post-menopausal osteoporosis has never been evaluated in a randomized trial. The objective of this study was to compare the effects of 5 and 20 mg of isosorbide mononitrate (ISMO) on markers of bone turnover in post-menopausal women. METHODS: A prospective randomized trial was carried out in the Department of Obstetrics & Gynecology, Ain Shams University, Egypt. The study included 50 healthy post-menopausal women with a hip bone mineral density T score between 0 and -2.5. Participants were randomly assigned to 5 or 20 mg/day of ISMO for 12 weeks. Urine N-telopeptide (NTx), a marker of bone resorption, and serum bone-specific alkaline phosphatase (BSALP), a marker of bone formation, were measured. Markers were measured immediately before randomization and after 12 weeks of treatment. The percent change in NTx and BSALP for each of the treatment groups (5 mg ISMO and 20 mg ISMO) was calculated. The main outcome measures were serum NTx and BSALP in the 5 and 20 mg ISMO groups after 12 weeks of treatment. RESULTS: Women adhering to 20 mg of ISMO had a 42.03% (95% confidence interval (CI), 20.1-73.7) reduction in NTx and a 29.05% (95% CI, 10.8-48.4) increase in BSALP, and women adhering to 5 mg of ISMO had a 31.12% (95% CI, 8.3-68.2) reduction in NTx and a 28.4% (95% CI, 4.6-52.1) increase in BSALP. CONCLUSION: ISMO, as a NO donor, may be useful for the prevention of post-menopausal osteoporosis.

Alkaline Phosphatase↗
PubMed1989

Blood volume and right heart haemodynamics in abrupt hypotension following sublingual isosorbide dinitrate in acute myocardial infarction.

Arterial blood pressure and heart rate were measured in 43 patients with acute myocardial infarction and a systolic blood pressure greater than or equal to 120 mmHg during sublingual administration of 5 mg of isosorbide dinitrate. In 25 of them right heart haemodynamics were also measured. Severe (greater than or equal to 25%) hypotension developed in 12 patients (Group 1, systolic blood pressure 158 +/- 28 to 78 +/- 17 mmHg, mean +/- SD) but not in the remaining 31 (Group 2) and was accompanied by a fall in heart rate (82 +/- 20 to 70 +/- 22 beats min-1, P less than 0.05), in cardiac output (4.3 +/- 0.3 to 3.2 +/- 0.41 min-1, P less than 0.02, n = 5) and in systemic vascular resistances (2326 +/- 463 to 1532 +/- 442 dynes sec-1 cm.5, P less than 0.02) not present in Group 2. The reduction in right (Group 1, 8 +/- 3 to 3 +/- 1, vs. Group 2, 10 +/- 3 to 6 +/- 3 mmHg, P less than 0.005) and in left ventricular filling pressures (Group 1, 15 +/- 4 to 8 +/- 2, vs. Group 2, 18 +/- 6 to 13 +/- 5 mmHg, P less than 0.001) was more remarkable in Group 1. In this group there was also a high incidence of anterior infarction (9/12, 75%).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Sublingual↗