title: Prevention of nitroglycerin tolerance with diuretics.
abstract: Tolerance to prolonged nitroglycerin (NTG) may be due to drug-induced intravascular expansion. To test the hypothesis that concomitant diuretics may reduce volume expansions and thus prevent NTG tolerance, we studied 23 healthy volunteers randomized to hydrochlorthiazide or placebo before and during 74-hour continuous NTG exposure. Venodilator response to NTG was tested serially with venous forearm plethysmography. In the preNTG patch phase venodilator response was similar in both the placebo and diuretic groups. Venodilator capacity was compared after "acute" (2-hour) and "chronic" (74-hour) NTG exposure with NTG patches. Attenuation to NTG was seen in the placebo group, but NTG venodilator activity was fully maintained in the diuretic group. These data suggest that diuretics may be helpful in the prevention of NTG tolerance.
authors.affiliation: Department of Medicine, George Washington University, Washington, DC 20037, USA.
authors.forename: N
authors.initials: N
authors.lastname: Mohanty
authors.forename: A G
authors.initials: AG
authors.lastname: Wasserman
authors.forename: P
authors.initials: P
authors.lastname: Walker
authors.forename: R J
authors.initials: RJ
authors.lastname: Katz
mesh_terms: D000284:Administration, Oral; D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D004311:Double-Blind Method; D004361:Drug Tolerance; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage*; D010991:Plethysmography / Q000187:drug effects / Q000379:methods; D012016:Reference Values; D013997:Time Factors; D014664:Vasodilation / Q000187:drug effects
chemical_list: D006852:Hydrochlorothiazide; D005996:Nitroglycerin