Effect of buccal nitroglycerin on pulmonary artery pressure at rest and during exercise: a comparison with sublingual nitroglycerin in patients with coronary artery disease.
60 patients with ischemic heart disease and angina pectoris, aged 42 to 74 years (mean 59), were included in this randomized study. All suffered from coronary disease demonstrated by ECG changes and/or positive exercise test results. Twenty percent of the patients had coronary angiograms revealing significant CAD. All patients had had typical angina pectoris episodes for a period of 22 +/- 10 months at a frequency of 4 +/- 2 attacks a week. A positive response to sublingual nitroglycerin was observed in all patients. The patients were randomly assigned to four groups (1 mg, 2.5 mg, or 5.0 mg buccal nitroglycerin and a control group with 0.8 mg sublingual nitroglycerin). Exercise testing was done by bicycle ergometer in the recumbent position at maximal work loads in 3-min periods; hemodynamic measurements were performed using a pulmonary artery catheter (Grandjean). Pulmonary artery pressure, heart rate, systemic blood pressure, and ST-segment changes in the ECG were recorded before administration of the drug as well as 5, 15, 30, 60, 120, and 180 s after administration. Exercise tests were performed 3, 30, and 180 min after administration. The study demonstrates that buccal Synchron nitroglycerin has immediate hemodynamic and clinical effects, documented by the reduction in pulmonary artery pressure values at rest and exercise and the increase in exercise tolerance and cardiac output. The best antianginal effects were achieved with the dosage of 2.5 mg buccal nitroglycerin. We conclude that buccally administered nitroglycerin has early effects similar to those of nitroglycerin administered sublingually; the hemodynamic and clinical effects, however, persist over a minimum of 180 min.
D001794:Blood Pressure / Q000187:drug effects*; D003327:Coronary Disease / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000494:pharmacology; D010101:Oxygen Consumption / Q000187:drug effects; D005082:Physical Exertion; D011651:Pulmonary Artery / Q000187:drug effects
D003692:Delayed-Action Preparations; D005996:Nitroglycerin