title: Nitrate induced coronary vasodilatation: differential effects of sublingual application by capsule or spray.
abstract: BACKGROUND
  Sublingual nitroglycerin (glyceryltrinitrate, GTN) capsules or isosorbide dinitrate (ISDN) spray are routinely used to treat anginal attacks and to vasodilate maximally the epicardial coronary arteries during coronary angiography.
  
  
  OBJECTIVE
  To compare the coronary vasodilatory effects of GTN capsules and ISDN spray with those induced by intracoronary GTN using quantitative coronary angiography.
  
  
  METHODS
  96 patients (79 men and 17 women; median age 59 years) were randomised to four groups to receive either a sublingual capsule containing 0.8 mg GTN or two puffs of spray delivering 0.8 mg ISDN, followed or preceded by an intracoronary bolus of 0.2 mg GTN used as reference for maximal vasodilatation.
  
  
  RESULTS
  There was a significant increase in the mean diameter of coronary arteries in angiographically normal segments in patients who received either intracoronary GTN (groups 1 and 2) or ISDN spray (group 4) as a first application (group 1, 0.46 mm, + 17%, (baseline vessel diameter 100%), p < 0.001; group 2, 0.45 mm, + 13%, p < 0.001; group 4, 0.47 mm, + 13%, p < 0.05). Patients who received a sublingual GTN capsule as the first application mode (group 3) had no significant change in epicardial vessel diameter (0.10 mm, + 5%, p = 0.3).
  
  
  CONCLUSIONS
  Sublingual ISDN spray may be more efficacious than sublingual GTN capsules in certain patients with anginal attacks. ISDN spray should be preferred over capsules in coronary angiographic procedures.
authors.affiliation: Division of Cardiology, University Hospital, Berne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Pfister
authors.forename: C
authors.initials: C
authors.lastname: Seiler
authors.forename: M
authors.initials: M
authors.lastname: Fleisch
authors.forename: H
authors.initials: H
authors.lastname: Göbel
authors.forename: T
authors.initials: T
authors.lastname: Lüscher
authors.forename: B
authors.initials: B
authors.lastname: Meier
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000286:Administration, Sublingual; D000328:Adult; D000336:Aerosols; D000368:Aged; D000704:Analysis of Variance; D002214:Capsules; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000336:Aerosols; D002214:Capsules; D014665:Vasodilator Agents; D005996:Nitroglycerin; D007548:Isosorbide Dinitrate