title: Effects of diuretic therapy on the development of tolerance during continuous therapy with nitroglycerin.
abstract: OBJECTIVE
  This study examined the effects of concurrent diuretic therapy on the hemodynamic responses to short-term and sustained therapy with transdermal nitroglycerin.
  
  
  BACKGROUND
  Sodium retention and plasma volume expansion occur during therapy with nitroglycerin and may play a role in the loss of nitroglycerin effects during sustained therapy.
  
  
  METHODS
  Twenty-two normal male volunteers were treated for 1 week with either hydrochlorothiazide and amiloride (50 + 5 mg) (n = 11) or placebo (n = 11) in a randomized, double-blind fashion. All 22 subjects then received continuous transdermal nitroglycerin (19 +/- 1 mg/24 h) for 5 to 7 days.
  
  
  RESULTS
  On the first and last day of transdermal nitroglycerin therapy, standing heart rate, systolic blood pressure and hematocrit values were assessed at 8, 9 and 10 AM and 12 noon. Heart rate and blood pressure responses to sublingual nitroglycerin (0.6 mg) were also evaluated before and after sustained transdermal nitroglycerin therapy. A significant loss of the hemodynamic effects of transdermal and sublingual nitroglycerin occurred during sustained therapy in both the diuretic and placebo therapy groups. In both groups, transdermal nitroglycerin therapy was associated with a significant decrease in hematocrit that persisted for the entire treatment period.
  
  
  CONCLUSIONS
  These results suggest that diuretic therapy does not prevent plasma volume expansion or the loss of hemodynamic effects during sustained transdermal nitroglycerin therapy. The persistent decrease in hematocrit suggests that plasma volume expansion plays a role in the attenuation of nitrate effects. It also provides evidence of continued vascular activity of nitroglycerin despite loss of systemic hemodynamic effects.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: J D
authors.initials: JD
authors.lastname: Parker
authors.forename: B
authors.initials: B
authors.lastname: Farrell
authors.forename: T
authors.initials: T
authors.lastname: Fenton
authors.forename: J O
authors.initials: JO
authors.lastname: Parker
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000584:Amiloride / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004347:Drug Interactions / Q000502:physiology; D004359:Drug Therapy, Combination; D004361:Drug Tolerance / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects; D006400:Hematocrit; D006801:Humans; D006852:Hydrochlorothiazide / Q000494:pharmacology*; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D010953:Plasma Volume / Q000187:drug effects*
chemical_list: D006852:Hydrochlorothiazide; D000584:Amiloride; D005996:Nitroglycerin