Safety of nitrate withdrawal in angina-free and hemodynamically stable patients with coronary artery disease.
OBJECTIVE
To assess the consequences of nitrate withdrawal in angina-free and hemodynamically stable coronary patients.


METHODS
Prospective, open, intervention study.


METHODS
Cardiology outpatient clinic of a university-affiliated municipal hospital.


METHODS
Angina-free patients who were hemodynamically stable for at least 3 months before study onset were enrolled. They were all regularly receiving nitrates for symptom control. Those with significant reasons to avoid stopping nitrates, such as heart failure (ejection fraction <35%) or high BP (> 160 mm Hg systolic and/or > 100 mm Hg diastolic), and noncompliant patients were excluded.


METHODS
After providing informed consent and undergoing an exercise test (whenever possible), the participants were randomized to abruptly discontinue (study group) or continue (control group) nitrate treatment. Follow-up continued for at least 3 months after study entry.


RESULTS
Eighty patients were randomized to the study group and 40 patients to the control group (mean age [+/- 1 SD], 65.5 +/- 11 years and 66.1 +/- 10.9 years, respectively; p = not significant). The first month, eight study patients (10%) had a recurrence of anginal symptoms, compared with one control subject (2.5%) [p = not significant]. All eight patients responded promptly and favorably to the resumption of nitrate administration.


CONCLUSIONS
Nitrate administration can be safely discontinued in angina-free and hemodynamically stable coronary patients who receive this medication on a regular basis. If relapse of anginal symptoms occurs, it will be within 1 month following nitrate withdrawal, and will resolve satisfactorily with reinstatement of treatment.
George
Jacob
J
Department of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Kitzis
Ilan
I
Zandorf
David
D
Golovner
Michal
M
Shapira
Itzhak
I
Laniado
Shlomo
S
Roth
Arie
A
D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy*; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D008297:Male; D011446:Prospective Studies; D012449:Safety; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate