Download e-book for kindle: Advances in Nitrate Therapy by Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)

By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)

ISBN-10: 3642970664

ISBN-13: 9783642970665

ISBN-10: 3642970680

ISBN-13: 9783642970689

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For nitrates, however, the initial hypotensive effect is almost always very rapidly attenuated. Beta-blockers have specific adverse effects, such as cold extremities, vivid dreams and impotence, which are almost never observed with nitrates. Verapamil causes constipation which might be intolerable, particularly in elderly patients. Nifedipine causes edema in about 20% of the patients. Headache, which often accompanies the initiation of nitrate therapy might be intolerable in some patients. No large-scale studies have specifically compared the frequency of adverse effects of the three classes of antianginal agents.

All these studies evaluated the development of tolerance in the peripheral vasculature. It should be remembered, however, that nitrates also have a dilator effect on the coronary arteries, which probably contributes to their antianginal effect. Stewart et al [95] have observed tolerance to the dilator effect of nitroglycerin on large coronary arteries in dogs. It is difficult to apply the findings ofthese studies to the clinical use of nitrates. The studies are not relevant for patients with congestive heart failure in whom many compensatory and regulatory mechanisms are maximally activated even before treatment.

Only in the past 15 years have they been recognized as affecting large numbers of patients. Extensive studies of angina at rest followed the development of calcium antagonists, which were considered very effective in this condition. It was found that angina at rest and variant angina usually result from changes in coronary tone. The most important of these is coronary spasm: a local increase in coronary tone in a short segment of the vessel. However, also a more generalized increase in coronary tone, although of less extent than coronary spasm, can sometimes result in angina.

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Advances in Nitrate Therapy by Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)


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