title: High-dose isosorbide dinitrate in management of angina pectoris.
abstract: The hypothesis was tested that selected patients with coronary artery disease whose rate of angina attacks do not respond to low doses of isosorbide dinitrate (ISDN) (40 mg/day) may respond to high doses (480 mg/day), tolerate them, and maintain their responsiveness over the long term. Twenty-four patients with grade 3 stable angina pectoris were given a placebo for 4 weeks and then had their ISDN dosages titrated up to 120 mg four times a day during another 6 weeks in a single-blind fashion. The 20 patients who responded to (and tolerated) a high dose of ISDN were maintained at that dose for an average of 1 year. The weekly rate of angina attacks fell by 74%, from 6.05 during placebo to 1.6 (p less than 0.01) during long-term ISDN treatment. Nitroglycerin consumption fell similarly. Patient assessment of activity level, well-being, and angina threshold improved in the majority of patients. The within-patient trend of their weekly rate of angina episodes was stable in 13 patients, downward in six, and upward in only one patient. Exercise performance evaluated by a submaximal graded multistage treadmill test showed a small but nonsignificant improvement of 1.8%. It is concluded that (1) some patients who do not respond to the antianginal action of low-dose ISDN may respond to a high dose and tolerate it, (2) this responsiveness and tolerability may last for over a year, and (3) ISDN may be clinically useful in patients with coronary disease even when exercise performance is not significantly improved.
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D004334:Drug Administration Schedule; D005080:Exercise Test; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D010349:Patient Compliance; D011674:Pulse / Q000187:drug effects; D013997:Time Factors
chemical_list: D005996:Nitroglycerin; D007548:Isosorbide Dinitrate