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At least 811 records · Page 45Linked to original sources
PubMed1998

Acute effect of propranolol and isosorbide-5-mononitrate administration on renal blood flow in cirrhotic patients.

BACKGROUND: Propranolol and isosorbide-5-mononitrate (ISMN) are increasingly used in the prophylaxis of variceal haemorrhage in cirrhosis. However, recent studies have suggested that these drugs may compromise renal function, possibly by reducing renal blood flow. AIMS: To assess the acute effects of propranolol and ISMN on renal blood flow and other haemodynamic parameters in cirrhosis. PATIENTS AND METHODS: Twenty six cirrhotic patients were given either 80 mg propranolol, 20 mg ISMN, or a combination of the two drugs. Unilateral renal blood flow (RBF), azygos blood flow (AZBF), hepatic venous pressure gradient (HVPG), mean arterial pressure (MAP), and heart rate (HR) were recorded prior to and one hour after drug administration. RESULTS: Propranolol caused a reduction in HR (p < 0.005), AZBF (p < 0.01), and HVPG (p = 0.05), but no change in MAP or RBF (454.1 (77.3) versus 413.9 (60.3) ml/min). ISMN reduced MAP (p < 0.005) and HVPG (p < 0.01), but had no effect on HR, AZBF, or RBF (302.5 (49.4) versus 301.7 (58.8) ml/min). Combined treatment reduced MAP (p < 0.005), AZBF (p < 0.05), and HVPG (p = 0.002), but HR and RBF (419.2 (62.6) versus 415.1 (61.1) ml/min) remained unchanged. CONCLUSIONS: Despite the anticipated changes in other haemodynamic parameters, acute propranolol and/or ISMN administration did not reduce RBF. These drugs do not seem to compromise RBF in cirrhosis.

Adult↗
PubMed2004

Nicorandil versus isosorbide dinitrate as adjunctive treatment to direct balloon angioplasty in acute myocardial infarction.

OBJECTIVE: To compare the effects of nicorandil (a hybrid ATP sensitive potassium channel (K+(ATP) channel) opener/nitric oxide donor) with those of isosorbide dinitrate (ISDN) on myocardial microcirculation and cardiac function in patients with acute myocardial infarction (AMI) who had undergone reperfusion treatment by direct balloon angioplasty. DESIGN: Double blind randomised study. PATIENTS: 60 patients with AMI in Killip class I. INTERVENTIONS: Patients were assigned into two treatment groups: a nicorandil group (n = 30) and an ISDN group (n = 30). Each drug was infused intravenously at 6 mg/h for 72 hours starting at admission and was administered directly to the treated coronary artery immediately after angioplasty. RESULTS: Compared with ISDN, nicorandil more frequently caused recovery of ST segment elevation just after reperfusion (15 of 27 (55.5%) in the nicorandil group v 5 of 26 (19.2%) in the ISDN group, p = 0.006). The nicorandil group had higher values of averaged peak velocity 40 minutes after reperfusion (mean (SD) 24.8 (13.3) cm/s v 16.0 (11.1) cm/s, p = 0.045) and higher values of regional wall motion of the infarcted area three weeks after onset of AMI (-1.78 (1.11) v -2.50 (1.04) SD/chord, p = 0.046). CONCLUSIONS: A combination of nicorandil drip infusion starting before reperfusion and intracoronary injection immediately after reperfusion is more effective than a similarly performed infusion of ISDN in preserving myocardial microcirculation in the reperfused AMI area. The nicorandil regimen resulted in better left ventricular regional wall motion.

Angioplasty, Balloon↗
PubMed1980

Dilation of coronary artery stenoses after isosorbide dinitrate in man.

The effect of isosorbide dinitrate (ISDN), 5 mg sublingually, on the diameters of coronary artery stenoses (n = 27) was examined in 20 patients. Another 18 patients with angiographically normal coronary arteries received the same amount of ISDN and were used as controls. Prestenotic and stenotic diameters were measured with a vernier calliper having an accuracy of 0.05 mm. The degree of stenosis was expressed as percentage of cross-sectional area reduction. ISDN caused uniform dilatation of every normal epicardial artery; mean increase in diameter was 21 per cent (range: 17 to 26%). In 18 stenoses (28 to 95% obstruction) there was very little change after ISDN. The mean prestenotic diameter increased from 2.82 +/- 0.48 mm to 3.05 +/- 0.43 mm and the mean stenotic diameter from 1.45 +/- 0.49 mm to 1.59 +/- 0.51 mm. However, in the nine other stenoses (35 to 89% obstruction) the mean degree of obstruction decreased significantly from 68 +/- 15.6 per cent to 47 +/- 15.6 per cent after ISDN. This improvement was a result of a significant increase of the mean stenotic diameter from 1.71 +/- 0.47 mm to 2.41 +/- 0.55 mm, whereas the prestenotic diameter showed only an insignificant increase from 3.17 +/- 0.63 mm to 3.31 +/- 0.58 mm after ISDN. In four patients with two obstructions in different coronary branches ISDN dilated one without significantly affecting the other lesion. From the data we conclude that ISDN can dilate some coronary artery stenoses but that this response may vary from one site to another even in the same patient.

Coronary Disease↗
PubMed1986

Effects of captopril and a combination of hydralazine and isosorbide dinitrate on myocardial sympathetic tone in patients with severe congestive heart failure.

Changes in circulating catecholamines and transmyocardial catecholamine balance associated with improved left ventricular function were studied in patients with chronic heart failure after treatment with captopril (10 patients) and hydralazine in combination with isosorbide dinitrate (eight patients). Cardiac performance improved in response to both captopril and hydralazine-nitrate treatment. The systemic haemodynamic effects were also qualitatively similar, but the hydralazine-nitrate combination caused a greater increase in cardiac index and heart rate. Captopril did not change arterial adrenaline concentrations (0.63 to 0.60 nmol/l), arterial noradrenaline (4.2 to 3.9 nmol/l), or net transmyocardial noradrenaline release (390 to 317 pmol/min), while hydralazine-nitrate increased arterial adrenaline (0.91 to 1.47 nmol/l) and transmyocardial noradrenaline release (225 to 554 pmol/min). Although both captopril and hydralazine-nitrate treatment improve left ventricular performance in patients with chronic heart failure, hydralazine-nitrate enhances cardiac sympathetic tone and captopril does not. The clinical relevance of these findings, however, is not known.

Aged↗
PubMed1998

In vivo three-dimensional EPR imaging of nitric oxide production from isosorbide dinitrate in mice.

Recently, in vivo electron paramagnetic resonance (EPR) spectroscopy and imaging have been widely used to investigate free radical distribution and metabolism in tissues, organs, and whole body of small animals. Endogenous nitric oxide (NO) is an attractive target of this method. In the present study, NO production from a nitrovasodilator, isosorbide dinitrate (ISDN), in live mice was investigated by in vivo EPR spectroscopy and imaging combined with the spin-trapping technique. A highly water-soluble Fe complex with N-(dithiocarboxy)sarcosine (DTCS) was used as an NO-trapping agent. Mice received [14N]-ISDN, and the Fe-DTCS complex subcutaneously exhibited the characteristic triplet EPR signal of the NO adduct [14NO-Fe(DTCS)2]2-. Using [15N]ISDN instead of [14N]ISDN, we were able to observe that the doublet EPR signal stemmed from the 15NO adduct, which directly demonstrated that NO was produced from ISDN. The three-dimensional EPR images of the upper abdomen of living mice showed that the NO adducts were distributed in the liver and the kidneys. This EPR image combined with the ex vivo EPR measurements of the blood suggested that NO production from ISDN occurred in the liver in this experimental condition.

Animals↗
PubMed1998

Effects on heart rate variability of isosorbide-5-mononitrate and metoprolol in patients with recent onset of angina pectoris.

BACKGROUND: Beta-blockers reduce sympathetic tone, increase vagal tone and improve prognosis in ischaemic heart disease. Nitroglycerin, being a vasodilator, may theoretically have an opposite effect and worsen the prognosis. The purpose of the present study was to analyse heart rate variability (HRV), which reflects autonomic tone, in angina patients on isosorbide-5-mononitrate (IS-5-MN) and/or metoprolol. METHODS AND RESULTS: Thirty-two patients (32-81 years old), with recently developed angina (median duration: 3 months), showing no other disease and on no drugs, were Holter-monitored 24-48 h at baseline and after 4-5 days on IS-5-MN (mean daily dose: 33 mg), on metoprolol (mean daily dose: 184 mg) and on the combined treatment. Recordings were analysed on the Marquette Series 8000 Holter scanner. Both IS-5-MN and metoprolol significantly reduced myocardial ischaemia (ST integral) and ventricular tachycardias. Metoprolol induced significant changes in the following parameters (baseline versus metoprolol): high-frequency peak 9 +/- 4 versus 11 +/- 4 ms (p < 0.001), low-to-high frequency ratio 2.5 +/- 0.6 versus 1.9 +/- 0.6 (p < 0.0001), root mean square of RR interval difference 23 +/- 7 versus 31 +/- 9 ms (p < 0.0001), RR intervals differing more than 50 ms from the preceding one 4.8 +/- 3.9 versus 10.0 +/- 7.0% (p < 0.0001), mean of all 5-min standard deviations 50 +/- 12 versus 56 +/- 11 ms (p < 0.001) and mean RR interval 819 +/- 90 versus 1,019 +/- 120 ms (p < 0.00001). The combined treatment caused approximately the same HRV changes as metoprolol alone. IS-5-MN had no significant effect on any HRV parameter, neither alone nor in combination with metoprolol. CONCLUSION: A clinically effective dose of metoprolol had potentially positive effects on HRV with increase in vagal and decrease in sympathetic tone while IS-5-MN had no effect on HRV, neither positive nor negative, neither alone nor in combination with metoprolol.

Adrenergic beta-Antagonists↗
PubMed1999

Effect of isosorbide-5-mononitrate on exercise performance and clinical status in patients with congestive heart failure. Results of the Nitrates in Congestive Heart Failure (NICE) Study.

BACKGROUND AND AIMS: Nitrate therapy improves hemodynamics in patients with heart failure, but the chronic effects of oral nitrates on exercise performance and clinical status have not been well studied. METHODS: Oral isosorbide-5-mononitrate (ISMN) (50 mg once daily) or placebo was administered to 136 patients (NYHA Class 2-3) treated for heart failure, all receiving captopril and most also furosemide. Endpoints were treadmill exercise time at 12 weeks by modified Naughton protocol (primary), with an additional 12-week follow-up period. Secondary endpoints included left ventricular dimensions, ejection fraction, cardiothoracic ratio, functional class, quality of life, hospitalizations and plasma norepinephrine and atrial natriuretic peptide in a four-center substudy. RESULTS: Intention-to-treat analysis showed that mean change in treadmill exercise duration tended to be greater in patients receiving ISMN than placebo (treatment difference +42 s, 95% CI -5, +90 s at 12 weeks and +21 s, 95% CI -25, +74 s after 24 weeks) (NS). Treatment difference was greater in the prespecified subgroup with ejection fraction 31-40% (+55 s, 95% CI -11, +136 s at 12 weeks and +65 s, 95% CI +3, +147 s) (p = 0.035) at 24 weeks. No deleterious effects (i.e. hypotension) were observed with ISMN, although headache was reported in 19% of the active treatment group (p = 0.0001). CONCLUSIONS: ISMN added to captopril increased treadmill exercise time in patients with heart failure and a lesser reduction in baseline ejection fraction, although for the group as a whole, the increase in treadmill time was not significant.

Administration, Oral↗
PubMed2000

Sublingual isosorbide dinitrate in the acute control of hypertension in patients with severe preeclampsia.

The objective of this study was to evaluate the effectiveness of sublingual isosorbide dinitrate (ID) in the acute control of hypertension in patients with severe preeclampsia. A randomized, double-blind clinical trial with a preinclusion period of response to hydration and rest was performed in 60 patients with severe preeclampsia. The treatment group (30 patients) received 5 mg of sublingual ID, a dose that could be repeated on a second occasion. The control group consisted of 30 patients who received placebo. Both groups continued with rest and hydration during the study. Maternal blood pressure and fetal heart rate were measured in all patients every 10 min until 1 h was completed. Treatment was considered effective when the diastolic blood pressure could be reduced to between 80 and 100 mm Hg. ID was effective in 56.6% of the patients in the first 10 min after its administration and in 96. 6% from 40 to 60 min. In the treatment group the systolic and diastolic blood pressures dropped gradually from 171 +/- 13 and 113 +/- 8 mm Hg, respectively, to 136 +/- 14 and 87 +/- 9 mm Hg. In the placebo group, blood pressure was not reduced. There was no significant difference in fetal heart rate between both groups throughout the study. In conclusion, ID was shown to be effective in the acute control of hypertension in patients with severe preeclampsia, where high blood pressure persists after a period of rest and hydration.

Administration, Sublingual↗
PubMed2001

Effect of isosorbide dinitrate on nitric oxide synthase under hypoxia.

Nitric oxide synthase (NOS) catalyzes nitric oxide (NO) formation from L-arginine in the presence of molecular oxygen and NADPH. NO is involved in the regulation of microvasculature. Isosorbide dinitrate (ISDN) and glyceryl trinitrate (GTN) have been widely used as vasodilators to treat acute myocardial ischemia, their biological effects being due to the release of NO. In this investigation, the effects of ISDN and GTN on NOS activity in the presence or absence of oxyhemoglobin under hypoxia and normoxia were studied. The apparent K(m) values for molecular oxygen were 21.6 +/- 1.5 and 9.4 +/- 1.3 micromol/l for nNOS and eNOS, respectively. ISDN liberated NO in a concentration- and pH-dependent manner, but no differences between hypoxia and normoxia were observed. The NO release from ISDN was also measured directly by an electron spin resonance spectral method with N-(dithiocarboxy)sarcosine-Fe complex as a NO-trapping agent. ISDN increased nNOS and eNOS activities in the presence of 30 micromol/l oxyhemoglobin under hypoxia, while it did not affect nNOS and eNOS activities under normoxia. In the absence of oxyhemoglobin, ISDN inhibited nNOS and eNOS activities under both hypoxic and normoxic experimental conditions. The rate of oxygen release from oxyhemoglobin under hypoxia was increased 3 times in the presence of 1 mmol/l ISDN. In contrast to ISDN, GTN could not release NO spontaneously, and it also did not affect nNOS and eNOS activities in the absence or presence of 30 micromol/l oxyhemoglobin under both hypoxic and normoxic conditions. These results indicated that the NO release from ISDN is different from that of GTN, and the increase of NOS activity by ISDN in the presence of oxyhemoglobin under hypoxia is ascribed to the increase in molecular oxygen concentration.

Animals↗
PubMed2003

Effect of isosorbide dinitrate ointment on anal fissure.

BACKGROUND/AIMS: Until recently, the treatment of choice for anal fissure was surgery, consisting of a partial lateral internal sphincterotomy. This treatment has a high complication rate: impaired continence is reported in 8-30% of the patients in the literature. Therefore, recently nonsurgical treatment modalities have been developed, such as local application of isosorbide dinitrate (ISDN) ointment. This treatment has comparable effectiveness with lower complication rates. To study the effect of ISDN on the healing of anal fissures in a general surgical practice, a prospective study was performed in our hospital. METHODS: In the period between June 1997 and January 2000, 100 consecutive patients with anal fissure were treated with ISDN. RESULTS: Of these 100 patients, 93 were healed within 8 weeks and 7 patients had no response and were operated. Of the 93 patients with primary healing fissures, 13 patients had recurrence during the 1-year follow-up. Seven of them were cured with ISDN, and the remaining 6 patients needed surgery. The only complication observed in this study was temporary headache which was observed in 7 patients. CONCLUSIONS: The primary healing rate of anal fissures was 93% with ISDN. In case of recurrence, 54% (7/13) could again be treated successfully with ISDN. Therefore, we recommend ISDN as first choice treatment for primary and recurrent anal fissures.

Administration, Topical↗
PubMed1985

Effect of sustained release isosorbide dinitrate on exercise performance.

The duration of action and hemodynamic mechanisms of isosorbide dinitrate in a sustained release formula (ISDSR) were examined over a 24-hour period. 20 patients with effort angina pectoris were divided randomly into two groups, one group received a single dose of 40 mg ISDSR (at 07.30 h) and the other, two doses of 40 mg ISDSR (at 07.30 and 13.30 h). Every patient had four exercise tests on the first (placebo) day and second (ISDSR) day and a single test on the third (placebo) day. Effort tolerance was improved significantly (p less than 0.05) with ISDSR and this lasted for more than 10 h. The double product was compared to ISDSR. Improvement was achieved by a decrease in blood pressure and an increase in heart rate. There were no signs of increased ischemia (ST segment depression) with the prolongation of exercise time. The antianginal and hemodynamic effects of ISDSR were more pronounced in the patients who received two doses of ISDSR. Thus, ISDSR improved effort tolerance for a prolonged period by inducing a sustained decrease of blood pressure and increase in heart rate in patients with effort-induced angina pectoris.

Adult↗
PubMed1987

Isosorbide 5-mononitrate pharmacokinetics.

Isosorbide 5-mononitrate differs from other clinically used organic nitrate vasodilators because of its almost complete oral absorption, the low intersubject variability in its plasma concentrations and pharmacokinetic parameters, its relatively long half-life and its lack of active metabolites. The drug does not appear to be bound to plasma proteins and it is metabolized primarily by denitration and conjugation. Its clearance is 127 ml/min, volume of distribution 48.5 litres and half-life 4.4 h. Its pharmacokinetics are linear over the dosage range likely to be used clinically. Sustained-release formulations of the drug could prove suitable for once-a-day administration. In disease states (cardiac, renal or hepatic), the plasma concentrations and pharmacokinetics of the drug appear to be similar to those in healthy subjects.

Humans↗
PubMed1987

Influence of isosorbide 5-mononitrate 20 mg, sustained-release 50 mg and sustained-release nifedipine 20 mg on ischaemic ST-segment changes during Holter monitoring. A double-blind cross-over study in patients with spontaneous angina pectoris.

Objective evidence of transient ischaemia can be obtained by ST-segment analysis of ambulatory ECG recordings. To compare the anti-ischaemic effects of isosorbide 5-mononitrate (IS 5-MN) and nifedipine in sustained-release formulations, we entered 16 patients with documented spontaneous ischaemic episodes in a double-blind cross-over study. The study consisted of four 1-week treatment periods with repeated 24-hour recordings at the end of each period. Nifedipine 3 X 20 mg/day was compared to IS 5-MN 3 X 20 mg/day and IS 5-MN 50 mg once daily for 1 week each. 12 patients completed the study protocol: 1 withdrew because of headache, 1 developed hyperthyroidism and in 2 patients the study was discontinued because the anginal symptoms became unstable. For the entire group both ways of treatment showed beneficial effects with significant reductions of the number of episodes (reduced by 65-68%, p less than 0.01), duration of episodes (reduced by 65-70%, p less than 0.05) and degree of ST deviation (reduced by 39-70%, p less than 0.05). With both IS 5-MN (7 of 12 and 6 of 12 patients) and nifedipine (5 of 12 and 8 of 12) a part of the group of patients became free of ischaemic episodes. In individual patients, however, different patterns of response were observed: 3/12 showed a complete response on both treatments, 1/12 was free on IS 5-MN only and 1/12 on nifedipine only.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1987

Oral isosorbide 5-mononitrate can protect from myocardial ischemia induced by ergonovine test and by isometric effort. Preliminary results from an echocardiographic acute study in anginal patients.

Isosorbide 5-mononitrate (IS 5-MN) has favourable pharmacodynamic properties, such as the specific half-life (close to 5 h) and the bioavailability (100% after oral ingestion). The efficacy of IS 5-MN (20 mg t.i.d.) in the treatment of stable angina has been documented in previous studies. In the present acute study, two subsets of patients were evaluated: the first group consisted of 10 patients with coronary vasospasm in whom oral IS 5-MN was effective in preventing myocardial ischaemia due to an abrupt reduction in coronary blood flow; the second group regarded 8 patients with a mixed form of angina, where the responsible mechanism for ischaemia can be considered a combination of increased myocardial oxygen demand and reduction of coronary blood flow due to vasoconstriction of large vessels. In all these patients, IS 5-MN was able to protect against transient myocardial ischaemia induced by isometric test. In conclusion, from the data available in our studies, IS 5-MN appears to be a useful drug in anginal patients: the beneficial effect is likely based on its capability both to prevent the abnormal vasoconstriction of diseased coronary vessels and to reduce myocardial oxygen demand.

Administration, Oral↗
PubMed1988

Anti-ischemic effects of slow-release formulations of nifedipine, isosorbide-5-mononitrate and their combination in patients with coronary heart disease.

Eighteen patients (2 females, 16 males) with coronary artery disease and a positive bicycle exercise test were treated with 50 mg slow-release isosorbide-5-mononitrate (ISMN SR) once daily, 20 mg nifedipine SR twice daily and a combination of both drugs during 2 weeks in a randomized double-blind sequence. Fifteen patients completed the study. The efficacy of each therapy was assessed by ECG stress testing after each treatment period. Both substances were equally effective in the reduction of ischemic ST depression: 0.40 +/- 0.22 mV with placebo, 0.31 +/- 0.16 mV during nifedipine SR and 0.31 +/- 0.29 mV during ISMN SR, 0.28 +/- 0.21 mV during the combination. However, during monotherapy with either nifedipine SR or ISMN SR 6 patients did not improve. The alternative monotherapy was effective in 3 out of 6 patients. Combination treatment gave further advantage only to one third of the patients. We conclude that both nifedipine and ISMN in slow-release formulations are equally effective in the treatment of myocardial ischemia. In the individual patient, however, therapy failure may occur. These patients should be switched to another monotherapy. If both monotherapies are ineffective, combination treatment should be considered.

Coronary Disease↗
PubMed1991

Evaluation of the antianginal and anti-ischemic efficacy of slow-release isosorbide-5-mononitrate capsules, bupranolol and their combination, in patients with chronic stable angina pectoris.

The effects of slow-release isosorbide-5-mononitrate (IS-5-MN), 25 mg once daily, bupranolol, 50 mg once daily, and their combination on exercise-induced ST-segment depression at comparable work load, maximal work load, exercise capacity, frequency of anginal episodes and sublingual nitroglycerin consumption were studied in 30 patients with chronic stable angina pectoris. The patients were assigned in a randomized, double blind protocol, to either form of monotherapy, for 12 days, and thereafter to combined therapy for 12 days. Exercise stress test was performed before treatment and at 2 and 16 h after drug administration on the first and 12th day of each treatment period. ST-depression at comparative work load at 2 h after dosing was reduced by 49% acutely after administration of IS-5-MN. This effect was not significantly altered after 12 days of treatment and during combined therapy. In those patients treated by bupranolol alone, an effect was observed only after 12 days - a 24% reduction in ST depression. At the 12th day of combined therapy ST-segment depression was reduced by 65%. At 16 h after dosing there was no significant reduction in mean values of ST-segment depression in either groups, but some patients in each group showed a sustained effect for 16 h. Both drugs increased maximal work load and exercise capacity at 2 h after administration. This effect was sustained in the IS-5-MN group also at 16 h after administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Isosorbide-5-mononitrate and atenolol in the treatment of stable exertional angina.

Fourteen men and six women, 48-68 years old, with stable angina and effort-induced ST-segment depression (ST-D) were treated with isosorbide-5-mononitrate (IS-5-MN) 2 x 40 mg/day and/or atenolol (AT) 100 mg/day in a double-blind randomized sequence during two 6-week periods. The patients performed ergometer tests. AT caused more decrease of heart rate at rest and at comparable work-load than IS-5-MN. Blood pressure at rest was in the normal range. Decrease of blood pressure at rest and at effort was similar with both agents. Combined administration of the two drugs was not more effective than monotherapy with AT or IS-5-MN in lowering heart rate and blood pressure. The average ST-D at comparable effort was for placebo 2.3 mm, for IS-5-MN after 2, 4, and 6 weeks, 3, 6, and 12 h, respectively, after medication, 1.4, 1.0, and 1.3 mm, and for AT 1.2, 1.4, and 1.4 mm, respectively. Administration of the drugs together caused additional highly significant reduction of ST-D (0.3-0.9 mm). The results indicate that IS-5-MN and AT have a similar beneficial effect on effort-induced myocardial ischemia, which is enhanced by their combined administration. The drugs alone and in combination are effective for as long as 12 h after administration of IS-5-MN, and 24 h after administration of AT. Moderate signs of tolerance to IS-5-MN were found after 6 weeks of therapy.

Aged↗
PubMed1991

Evaluation of the antianginal effect of isosorbide-5-mononitrate in patients with chronic stable angina pectoris.

The antianginal and anti-ischemic properties of isosorbide-5-mononitrate (ISMN) were evaluated in 40 patients with chronic stable angina pectoris in a randomized double-blind parallel-group placebo-controlled study. After 2 weeks' placebo run-in period the patients were randomized to either ISMN, orally 20 mg 2-3 times daily (titrated) or placebo. They underwent bicycle exercise stress test at the end of the placebo period and after 4 weeks of treatment. Compared with placebo ISMN increased the exercise performance, reduced ST-segment depression, anginal frequency and sublingual nitroglycerin consumption. All these changes were statistically significant. It may be concluded that ISMN is an effective antianginal and anti-ischemic agent in patients with chronic stable angina pectoris.

Adult↗