title: Lack of rebound during intermittent transdermal treatment with glyceryl trinitrate in patients with stable angina on background beta blocker.
abstract: OBJECTIVE
  To assess whether intermittent transdermal treatment with glyceryl trinitrate causes clinically significant rebound in patients maintained on beta blockers for stable angina pectoris.
  
  
  METHODS
  Serial treadmill exercise testing in a double blind, randomised, placebo controlled cross over trial. Baseline exercise testing was performed at 0900 and 1100 at visit 1. Transdermal glyceryl trinitrate patches releasing 15 mg/24 h were applied at 2200 the evening before visits 2 and 3, and exercise testing was performed at 0900 the next morning. The patch was removed and replaced with either an identical patch or matching placebo and exercise tests were repeated two hours later. The alternative treatment was given at visit 3.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  14 patients with stable angina pectoris maintained on beta blocker treatment alone.
  
  
  METHODS
  Time to angina, 1 mm ST segment depression, and total time, together with heart rate, systolic blood pressure, and rate-pressure product.
  
  
  RESULTS
  Active treatment improved treadmill performance at 0900 and 1100. Time to angina, time to 1 mm ST segment depression, and total time fell significantly on placebo compared with the 0900 exercise test on active treatment, but were not significantly different to the baseline exercise test either.
  
  
  CONCLUSIONS
  Intermittent transdermal treatment with glyceryl trinitrate is not associated with the rebound phenomenon in patients maintained on beta blockers for stable angina pectoris.
authors.affiliation: Royal Brompton National Heart and Lung Hospital, London.
authors.forename: D R
authors.initials: DR
authors.lastname: Holdright
authors.forename: R J
authors.initials: RJ
authors.lastname: Katz
authors.forename: C A
authors.initials: CA
authors.lastname: Wright
authors.forename: J L
authors.initials: JL
authors.lastname: Sparrow
authors.forename: A K
authors.initials: AK
authors.lastname: Sullivan
authors.forename: A D
authors.initials: AD
authors.lastname: Cunningham
authors.forename: K M
authors.initials: KM
authors.lastname: Fox
mesh_terms: D000279:Administration, Cutaneous; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000787:Angina Pectoris / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005080:Exercise Test; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*
chemical_list: D000319:Adrenergic beta-Antagonists; D005996:Nitroglycerin