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PubMed1995

[Isosorbide-5-mononitrate in silent ischemia].

Thirty six patients with documented coronary artery disease and exercise-induced silent ischemia were evaluated in a double-blind randomised placebo-controlled crossover study. The effect of once daily 60 mg sustained-release isosorbide-5-mononitrate (IS-5-MN) was tested on exercise-induced and ambulatory silent ischemia. After a wash-out period in which no cardioactive drugs were administered, each patient received IS-5-MN for the first week, followed by placebo for the second week, or vice versa. A symptom-limited bicycle exercise test and Holter monitoring over a 24-hour period were performed after wash-out and at the end of each one-week treatment period. In comparison with wash-out IS-5-MN significantly (p < 0.05) prolonged time on onset of 1 mm ST-segment depression during exercise testing. On the other hand, the number and circadian variation of ischemic episodes during Holter monitoring were not influenced by IS-5-MN. Thus, 60 mg IS-5-MN once daily significantly improved silent ischemia during exercise testing but not during Holter monitoring. This discrepancy may be due to different pathogenetic mechanisms of ischemia during ergometry as opposed to the everyday situation; nitrates may also provoke silent ischemia by increasing the heart rate. Furthermore, the choice of only one antiischemic drug at a fixed dosage may not be aggressive enough in suppressing ischemia completely.

Adult↗
PubMedDate not supplied

[The relationship between the isosorbide-5-mononitrate concentration and its antianginal effect following the administration of regular and prolonged-action drug forms in patients with stenocardia of effort].

Isosorbide-5-mononitrate (IMN) concentration-antianginal effect relationships were studied in 14 coronary heart diseases patients with stable exertion-induced angina after administration of Efox (Schwarz-Pharma) as two dosage forms: routinely acting tablets (20 mg) and long-acting capsules (50 mg). The antianginal effect index was an increase of treadmill exercise duration (sec) as compared with placebo, the concentration and effect were measured in points 0, 1, 3, and 7 hours after administration, in some patients, investigations were conducted 12 and 24 hours. The two formulations were found to be highly effective drugs whose action lasted 7 hours, by that time the effect of the tablets substantially decreased, which was associated with decreases in drug concentrations. The efficiency of the capsules at this point was significantly higher than that of the tablets. The use of the capsules resulted in tachyphylaxis--rapid decreasing responses to IMN. Following 7 hours of their administration there is a significant decrease in their effect with an increase in IMN concentrations.

Angina Pectoris↗
PubMed1995

Evaluation of the pharmacokinetics and absolute bioavailability of three isosorbide-5-mononitrate preparations in healthy volunteers.

The objective of this study was two-fold: 1. to determine the pharmacokinetic parameters and the bioavailability of two 20 mg isosorbide-5-mononitrate (CAS 16051-77-7, IS-5-MN) preparations (treatments A and B) after single oral administration and 2. to evaluate the absolute bioavailability of IS-5-MN, which was possible by the administration of a third IS-5-MN preparation (treatment C) by the intravenous route (1 mg/ml, dose 20 mg). The three preparations were examined in 24 healthy volunteers according to a randomized 3-way cross-over design, blood samples were withdrawn up to 24 h following the administration of IS-5-MN and plasma concentrations of IS-5-MN were quantified by a gas chromatography method. The two oral preparations led to peak concentration values of about 360 ng/ml of IS-5-MN in the mean 0.90 h (treatment A) and 0.97 h (treatment B) after drug administration. The corresponding values for the infusion were 339.6 ng/ml and 2.59 h in the mean. For the areas under the curve (AUC(0-infinity)) mean values of 2733 (treatment A). 2724 (treatment B) and 2877 h x ng/ml (treatment C) were found. The absolute bioavailability of both oral treatments revealed values of 95.00% and 94.74% for treatments A and B, respectively. The statistical comparison (ANOVA, confidence intervals) of the pharmacokinetic parameters showed bioequivalence between both oral preparations and equivalence in the amount of drug absorption between both oral formulations and the i.v.-infusion. The observed undesired side effects (e.g. headache or nausea) are well known to occur after IS-5-MN administration.

Administration, Oral↗
PubMed1994

Intravenous diltiazem versus isosorbide dinitrate for unstable angina: comparison of coronary angiographic morphology in the unstable and stabilized states.

BACKGROUND: The efficacy of intravenous infusion of diltiazem was compared with that of isosorbide dinitrate (ISDN) for the early treatment of unstable angina. METHODS: Sixty-four patients with at least 70% organic stenosis of the culprit artery and prolonged rest angina were enrolled. Coronary angiography was performed on admission. Subsequently, patients were randomly assigned to receive either intravenous diltiazem or ISDN. Coronary angiography was repeated when the angina was under control, and the findings were compared with those on admission. RESULTS: Diltiazem was more effective than ISDN, and symptoms were resolved in 84% of the diltiazem group compared with 47% of the ISDN group (P = 0.0038). Repeat coronary angiography showed that the degree of stenosis remained unchanged in the majority of patients (n = 47, 75.8%). There was no difference between the two groups with regard to the coronary angiographic findings. CONCLUSIONS: Since diltiazem was more effective than ISDN even though the coronary angiographic findings of the two groups were similar, it is possible that some action other than vasodilatation (such as a direct protective effect on the myocardium) may be responsible for the remission of unstable angina.

Aged↗
PubMed1995

[Prolonged treatment with isosorbide-5-mononitrate in patients with silent ischemia].

UNLABELLED: INTRODUCTION AND PURPOSES: The purpose of this study was to check the beneficial effect of isosorbide-5-mononitrate (IS-5-MN) in patients with myocardial postinfarction silent ischemia, and to evaluate the possible appearance of tolerance after prolonged treatment. METHODS: We have studied 20 patients, all males, with a history of infarction (11 with inferoposterior infarction and 9 with anterior infarction) and having a positive effort test by electrocardiographic criteria (ischemic S-T depression > 1 mm). The study was designed in two parts, first crossover with placebo, double-blind and then open during 100 days; until day 20, 40 mg/12 hours of IS-5-MN were administered and from then on 40 mg/8 hours of the drug. Effort tests were carried on days, 1, 20, 34 and 100, first basal ones and then at 3 and 6 hours after the administration of the medication. RESULTS: The time of S-T segment depression was prolonged in relation to the tests carried out with placebo and to its basal values (Placebo-basal: 235 +/- 97, Placebo-3 hours: 196 +/- 92, Placebo-6 hours: 201 +/- 80, day 1-basal: 197 +/- 84, day 1-3 hours: 420-96, day 1-6 hours: 381 +/- 93, day 20-basal: 221 +/- 81, day 20-3 hours: 384 +/- 121, day 20-6 hours: 389 +/- 112, day 34-basal: 272 +/- 91, day 34-3 hours: 437 +/- 102, day 34-6 hours: 362 +/- 100, day 100-basal: 269 +/- 102, day 100-3 hours: 389 +/- 112, day 100-6 hours 369 +/- 111). The duration of the effort was prolonged in relation to the placebo values (Placebo-basal: 480 +/- 100, Placebo-3 hours: 445 +/- 73, Placebo-6 hours: 430 +/- 79, day 1-basal: 450 +/- 95, day 1-3 hours: 510 +/- 79, day 1-6 hours: 532 +/- 86, day 20-basal: 524 +/- 93, day 20-3 hours: 535 +/- 77, day 20-6 hours: 519 +/- 77, day 34-basal: 517 +/- 85, day 34-3 hours: 567 +/- 87, day 34-6 hours: 558 +/- 94, day 100-basal: 520 +/- 89, day 100-3 hours: 593 +/- 91, day 100-6 hours: 590 +/- 92). This effect lasted throughout the 100 days of the study. CONCLUSIONS: Therefore, in patients with silent ischemia after myocardial infarction, the administration of 40 mg/12 hours as well as of 40 mg/8 hours of IS-5-MN shows an obvious anti-ischemic effect; with long-term treatment, the effect persists without evidence of tolerance phenomenon.

Adult↗
PubMed1994

Efficacy of eccentric dosing with sustained-release isosorbide dinitrate in patients with angina pectoris.

OBJECTIVE: To assess the anti-anginal efficacy of eccentric dosing with a sustained-release formulation of isosorbide dinitrate (ISDN) administered twice daily in an eccentric fashion (08:00 and 14:00). DESIGN: A placebo controlled crossover study of 16 patients with chronic stable angina who received, in random order, either placebo or sustained-release ISDN 40 mg twice daily for a period of seven to 10 days. Patients were entered who had reproducible exercise test to the development of moderate angina. All anti-anginal drugs with the exception of beta-blockers were withheld during the study period. The primary end-point was the treadmill walking time to the development of moderate angina. RESULTS: Patients receiving active therapy showed a significant increase in treadmill walking time to moderate angina over that seen with placebo at 3 and 6 h after the morning dose and 3 and 8 h after the afternoon dose. Similar trends occurred for the time to onset of angina and the time to development of 1 mm of ST segment depression on the electrocardiogram. CONCLUSIONS: Eccentric dosing with sustained-release ISDN, 40 mg given 6 h apart, provided significant improvement in exercise performance for up to 14 h during sustained therapy.

Angina Pectoris↗
PubMed1976

[Orally administered nitroderivates: efficacy and duration of the effects of isosorbide dinitrate (author's transl)].

The effects of 20 mg of orally administered isosorbide dinitrate on 10 patients with stable angina pectoris were studied by means of exercise tests. First, the reproducibility of the angina threshold of each patient was controlled; then the effects after 60, 150 and 210 minutes after administration of the drug and of a placebo, given in a random sequence, were studied. No significant changes of the parameters examined were observed after the placebo. A significant increase of duration of exercise and total amount of work performed before appearance of angina were observed after the drug. These changes were maximal in tests made 60 minutes after administration of the drug, declining thereafter; nevertheless, statistically significant differences from placebo were also observed in tests performed after 150 and 210 minutes. The appearance of ischemic ST changes was retarded by the administration of the drug. Disappearance of pain after interruption of exercise was significantly quicker when compared with the observations made after placebo.

Administration, Oral↗
PubMed1994

[Pharmacokinetics of isosorbide dinitrate studied by the extrapolation model].

To make a pharmacokinetic model of isosorbide dinitrate (ISDN), we infused ISDN at 1, 10 or 30 micrograms.kg-1.min-1 into anesthetized rabbits and measured concentrations of ISDN and its metabolites (2-ISMN and 5-ISMN) in plasma, urine and bile. We found the concentration gradient of ISDN between arteries and veins and between the ascending aorta and femoral artery. These concentration gradients may occur due to metabolism and accumulation of ISDN in many organs and tissues, let alone the vascular endothelium. There was no significant difference in plasma concentrations of ISDN or its metabolites between the hepatic vein and femoral vein. It seems that ISDN is metabolized in various organs and tissues. By ISDN infusion of more than 10 micrograms.kg-1.min-1, the plasma concentration of ISDN showed a pronounced increase. It appears that there is metabolic saturation of ISDN. Using these informations, we extrapolated the model to human and the estimated values were compared with observed values to determine the validity of the extrapolation model. There was no remarkable differences between the estimated values and observed values. This suggests the validity of the model. The plasma concentrations of ISDN, estimated by this extrapolated model, showed a linear increase (Y = 30X) with the flow rate range of 0.2-5.0 micrograms.kg-1.min-1, when the metabolic rate was normal. With ISDN infusion of more than 5.0 micrograms.kg-1.min-1, the plasma concentrations of ISDN showed a pronounced increase. In the conditions of impaired metabolism, the plasma concentrations of ISDN increase exponentially.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Sublingual isosorbide dinitrate to improve technetium-99m-teboroxime perfusion defect reversibility.

UNLABELLED: Previous studies demonstrate perfusion defect reversibility in 201Tl reinjection imaging performed after the administration of nitrates. This study tests whether the acute sublingual administration of isosorbide dinitrate (ISDN) could improve the capability of 99mTc-teboroxime to detect reversibility in exercise-induced perfusion defects. METHODS: Ten patients with previous myocardial infarction underwent exercise, redistribution and reinjection 201Tl imaging, 99mTc-teboroxime exercise and rest scans. Following the latter, 5 mg sublingual ISDN were given, 99mTc-teboroxime was reinjected and images collected. RESULTS: The total defect score/patient in the 201Tl images was 10.5 +/- 3.1 (mean +/- s.d.), decreasing to 7.4 +/- 2.7 after redistribution (p < 0.02) and to 4.8 +/- 2.1 after reinjection (p < 0.01 versus redistribution). The total defect score in 99mTc-teboroxime exercise images was 12.7 +/- 3.1 (p < 0.05 versus 201Tl exercise), decreasing to 7.3 +/- 3.3 at rest (p < 0.01 versus exercise, NS versus 201Tl redistribution) and to 5.6 +/- 2.6 in ISDN images (p < 0.02 versus rest, p < 0.05 versus 201Tl redistribution, NS versus reinjection). Of the 44 abnormal segments in 201Tl exercise images, the redistribution scan identified 26 defects as reversible and 18 as fixed. After reinjection, 37 defects appeared reversible and only seven fixed (p < 0.005 versus redistribution). Stress-rest 99mTc-teboroxime classified 33 segments as reversible and 11 as fixed (NS versus both 201Tl protocols). After ISDN, the uptake score increased in 19 segments. Therefore, 37 were classified as reversible and seven as fixed defects (p < 0.01 versus 201Tl redistribution, NS versus 201Tl reinjection). CONCLUSIONS: Sublingual ISDN before 99mTc-teboroxime rest injection seemed to improve the tracer capability of detecting reversibility in exercise-induced perfusion defects.

Administration, Sublingual↗
PubMedDate not supplied

Quantitative and qualitative modifications of lymphocyte subsets after sublingual administration of isosorbide dinitrate in migraineurs. Preliminary report.

In 22 migraine patients and 5 healthy controls an investigation has been performed on lymphocyte subsets in basal conditions and 90 minutes after sublingual isosorbide dinitrate (IDN) administration. In all patients the drug assumption induced a typical migraine attack with increase in all examined lymphocyte subsets with except of NK cells. A statistically significant increase (p < 0.05) in T lymphocyte subsets we found during the crisis, whereas in healthy controls neither a migraine attack nor any modification in lymphocyte subsets could be observed. These results seem to confirm the immune alteration we have previously found in migraineous patients and suggest the possible role of IDN-stimulated endothelium not only in vasodilatation but also in production of substances responsible of the observed immune modifications.

Administration, Sublingual↗
PubMed1993

[The efficacy of isosorbide dinitrate administered in an intravenous bolus in acute cardiogenic pulmonary edema].

STUDY OBJECTIVE: To evaluate the efficacy, safety and tolerability of intravenous (i.v.) isosorbide dinitrate (ISDN) administered as a bolus in the treatment of cardiogenic acute pulmonary edema (CAPE). DESIGN: Clinical, prospective, open, noncontrolled trial. SETTING: Emergency room. PATIENTS AND INTERVENTIONS: Twenty two patients (15 male and 7 female), aged 54 to 80 years (68.4 +/- 6.4) with severe respiratory distress consistent with CAPE were included. The cause of CAPE was chronic ischemic cardiopathy in 13 patients, acute myocardial infarction in four, hypertensive cardiopathy in three and mitral valve disease in two. Patients were excluded from the study because of shock or systolic blood pressure equal or lower than 100 mmHg, severe aortic stenosis, hypertrophic cardiomyopathy and non-cardiogenic pulmonary edema. All patients were placed in the sitting position and received oxygen. Initial therapy consisted of an i.v. bolus of 5 to 10 mg of ISDN. Clinical data were recorded at admission and after 5, 10, 15 and 30 minutes. A new i.v. bolus of ISDN and/or another drug was administered at 5 minutes, when necessary. RESULTS: Fifteen patients treated exclusively with ISDN (in three a second i.v. bolus was necessary) improved markedly. In the remaining seven patients that needed other drugs, the improvement was not so impressive. The mean total dose of i.v. ISDN was 10.34 +/- 3.48 mg. Although all data showed a trend towards improvement, just the following were statistically significant (p < 0.05): pH increased from 7.26 +/- 0.13 to 7.32 +/- 0.9, systolic blood pressure decreased from 192.7 +/- 34.8 mmHg to 155.0 +/- 24.4 mmHg (-19%) and diastolic blood pressure decreased 110.5 +/- 12.7 mmHg to 93.2 +/- 9.1 mmHg (-16%). CONCLUSIONS: In this trial, iv ISDN administered as a bolus in doses ranging from 5 to 20 mg, was effective and safe as a first line agent in the treatment of CAPE. No serious adverse reaction were reported.

Acute Disease↗
PubMed1993

[Effect of isosorbide dinitrate on pulmonary venous compliance].

Irreversible poor pulmonary venous compliance (PV comp) could worsened natural course of patients (pts) with high pulmonary capillary wedge pressure especially pts with mitral stenosis. Nitrates (isosorbide dinitrate-ISDN) possessing venous dilating action could increase PV comp in most of pts. The main aim of that study was to assess hemodynamic effects of ISDN, in pts with MS, with special emphasis on PV com changes. PV comp was estimated according to Hirakawa equation (dV/dp = 0.4*k2*SV/(v-d) in 35 pts with MS, during preoperative right heart catheterisation with VYGON 5155-180 thermodilution catheters during rest and effort in supine position (25W). The same protocol was performed after Iso-Mack sprawy 3.75 mg. According to the PV comp response to ISDN, pts were divided in two groups: good responders (I)-15% and higher increase in PV comp and poor responders (II). ISDN increased PV comp in the whole group according to the response to ISDN, there were significant differences in stroke volume index (SVI) and heart rate (HR). In the group of good responders mean right atrial pressure (RA), mean pulmonary artery pressure (PAP), mean pulmonary wedge pressure (PWP) decreased significantly with simultaneous slight not significant decrease in SVI and not significant increase of HR. In the group of poor responders SVI decreased significantly by about 20% with significant increase of HR. In conclusion significant decrease in pulmonary pressures (PAP, PWP) in pts with good response to ISDN are secondary to the increase of PV comp, while among poor responders the same effects are due to diminished flow secondary to the decrease of the systemic venous return.

Adult↗
PubMed1994

[Differential effects of isosorbide dinitrate and nitroprusside on pial vessel diameter in cats].

Changes in pial vessel diameter combined with regional cerebral blood flow (CoBF) during infusion of vasodilating drugs, isosorbide dinitrate (ISDN) 5 micrograms/kg/min and nitroprusside (NTP) 5 micrograms/kg/min, compared with haemorrhagic hypotension were studied in cats anesthetized with halothane (1.0%). Pial arteries and veins were measured by image-splitting technique and were each divided into three groups according to the reference diameter: I; < 50 microns, II; 51 < microns < 100, III; 101 < microns. With either drug, the mean blood pressure (mBP) decreased by 10-20%. There was significant decrease in cerebral vascular resistance with ISDN compared with haemorrhagic hypotension while CoBF (H2 clearance) remained unchanged. Dilatation of pial arteries depending on vessel size with ISDN was two-hold compared with haemorrhagic hypotension without any change in all veins. Consistent and significant dilation of veins (I and II) was observed only during NTP infusion. These findings indicate the differential effect of ISDN and NTP on pial arteries and veins.

Animals↗
PubMed1993

[Isosorbide-5-mononitrate in the prevention of digestive hemorrhage in cirrhosis: randomized study].

Isosorbide 5-mononitrate (5MI) is a preferential venous dilator that has been shown to decrease portal pressure in acute and long-term haemodynamic studies, and this is not associated with adverse effects on hepatic perfusion. The aim of this trial was to investigate the efficacy and safety of 5MI in the prevention of upper gastrointestinal bleeding in cirrhotic patients. Forty two cirrhotic patients with F2 or F3 esophageal varices showing "red signs" and who had never bled were included and randomly y assigned to receive either 5MI (group I,n23) or placebo (group P,n19). Patients with hepatocarcinomas or complications potentially lethal in the short-term or who were being given drugs such as steroids or interferon were excluded. The end points of the study were bleeding and death. There were no significant differences between the groups in the basal clinical and laboratory data. The mean +/- SD follow-up time was 49 +/- 36 and 43 +/- 25 weeks in the groups I and P, respectively. The percentage of patients free of bleeding 61 weeks after inclusion in the study was 62.4% in the group I and 46.3% in the group P (NS). The percentage of patients surviving 85 weeks after inclusion in the study was 81.2% in the group I and 39.8% in the group P (NS). Treatment did not have to be stopped in any patient of both groups because of side effects. In conclusion, 5MI is a safe drug for the chronic management of portal hypertension, that showed a trend to reduce the risk of bleeding and death in cirrhosis with large esophageal varices.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

[Long-term effects of sublingual isosorbide dinitrate (author's transl)].

The effect of 10 mg of sublingual isosorbide dinitrate were studied using exercise test in 10 patients with stable angina pectoris. First the reproducibility of angina threshold of each patient was controlled. then the effects after 30, 90, 150 minutes of the administration of the drug and a placebo, administered in random sequence, were studied. No significant changes of the parameters examined were observed after the placebo. Significant increase of duration of exercise and total amount of work performed before angina were observed after the drugs. Also, the appearance of electrocardiographic alterations was retarded, and disappearance of pain after exercise interruption was quicker. These changes were maximal in the tests made 30 minutes after administration of the drug, declining therafter; nevertheless, statistically significant differences from placebo were also observed in tests after 90 and 150 minutes.

Administration, Oral↗
PubMed1993

Influence of isosorbide dinitrate (ISDN) on compliance of the pulmonary venous system.

Irreversible poor pulmonary venous compliance can worsen the natural course of patients with high pulmonary capillary wedge pressure, especially those with mitral stenosis, but nitrates (isosorbide dinitrate--ISDN), which have venodilatory properties, could increase this compliance in most patients. The aim of this study was to assess the hemodynamic effects of ISDN in patients with mitral stenosis, with special emphasis on the pulmonary venous compliance. Pulmonary venous compliance was estimated according to the Hirakawa equation (dV/dp = 0.4 x k2 x sV/(v-d)) in 39 patients with mitral stenosis during preoperative right heart catheterization with Vygon 5155-180 thermodilution catheters at rest and during exercise (25 W) in the supine position. This procedure was repeated after the application of 3.75 mg of Iso-Mack spray. Overall, ISDN increased pulmonary venous compliance significantly both at rest and during exercise (6.0 to 7.5 ml/mmHg and 6.0 to 7.6 ml/mmHg, respectively). The patients were divided into two groups according to their level of ISDN response; those with a good response of an increase of 15% or more in pulmonary venous compliance (Group I), and those with an increase of less than 15% (Group II). There were significant differences between these two groups in stroke volume index and heart rate. In Group I, while the mean right atrial pressure, mean pulmonary artery pressure and mean pulmonary wedge pressure all decreased significantly, there was a simultaneous insignificant decrease in the stroke volume index and an also insignificant increase in the heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Function, Right↗
PubMed1993

Evaluation by patients with heart failure of the effects of enalapril compared with hydralazine plus isosorbide dinitrate on quality of life. V-HeFT II. The V-HeFT VA Cooperative Studies Group.

BACKGROUND: Two new questionnaires concerning the quality of life of patients with heart failure were used in a randomized, controlled trial to determine if the patients' perceptions of the effects of enalapril on their daily activities and sense of well-being were different from those of a group treated with hydralazine and isosorbide dinitrate. METHODS AND RESULTS: The questionnaires were completed at baseline and at 3 months, 6 months, and subsequently every 6 months during follow-up, which averaged 2.5 years (range, 0.5-5.7 years). Data from the questionnaires were reliable as indicated by correlation coefficients between repeated baseline scores of 0.88 and 0.87. Both treatment groups showed a progressive deterioration in quality of life as measured by both questionnaires. The questionnaire scores of the two treatment groups were not significantly different at any follow-up visit. Furthermore, there were no differences between treatments among subgroups defined by baseline questionnaire scores, peak oxygen consumption, ejection fraction, previous vasodilator use, and plasma norepinephrine concentration. CONCLUSIONS: Although several factors may limit the generalization of these results, the lack of a difference with regard to patients' quality of life is an important consideration for the evaluation of the relative therapeutic efficacy of these vasodilators.

Attitude to Health↗
PubMedDate not supplied

Comparison of anti-ischemic effects of isosorbide-5-mononitrate, metoprolol and diltiazem: a study based on serial treadmill exercise test.

A prospective double blind cross over study compared the anti-ischemic effect of 20 mg of isosorbide-5-mononitrate (IS-5-MN), 60 mg of diltiazem and 100 mg of metoprolol by performing serial treadmill tests (TMTs) following oral administration of single dose of each drug in 28 patients of ischemic heart disease with positive exercise TMT. The anti-ischemic effect of IS-5-MN, diltiazem and metoprolol was evaluated by assessing the time to onset of ischemia (400.8 +/- 41.1 vs 394.1 +/- 36.0 vs 412.7 +/- 36.6 secs respectively, all p > or = 0.05), duration of ischemia (390.9 +/- 58.5 vs 447.6 +/- 65.9 vs 419.4 +/- 58.7 secs respectively, all p > or = 0.05), duration of exercise 464.0 +/- 32.9 vs 476.8 +/- 32.5 vs 502.6 +/- 31.3 secs respectively, all p > or = 0.05) and severity of ischemia by scoring system (10.0 +/- 1.5 vs 10.7 +/- 1.4 vs 9.8 +/- 1.5 respectively, all p > or = 0.05). Thus, the present study suggests that there is no significant difference in the anti-ischemic effect of IS-5-MN, diltiazem and metoprolol and also suggests that the anti-ischemic effect of metoprolol is primarily by decreasing the heart rate while IS-5-MN and diltiazem exert anti-ischemic effect probably by decreasing oxygen demand and improving coronary blood flow.

Adrenergic beta-Antagonists↗