Mechanisms of tolerance during treatment with nitroglycerin patches for 24 h |
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Authors: | T O Klemsdal H H Mundal K Gjesdal |
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Institution: | Department of Cardiology, Ullev?l University Hospital, N-0407 Oslo, Norway, NO
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Abstract: | Objective:
We examined the relationship between tolerance development, counterregulatory responses and arterial vasodilating effects
evaluated by digital pulse plethysmography.
Methods:
Twenty patients with stable angina pectoris were exercise tested before, after 2 and after 24 h of open nitrate patch treatment.
Results:
The effects observed after 2 h of treatment on exercise duration, ST-segment depression, blood pressure and heart rate were
lost in most individuals after 24 h. In contrast, the effects on the arterial pulse curves persisted after 24 h, with a mean
change from baseline of 29%, compared to 33% at 2 h. After 24 h, a significant decrease in haematocrit and an increase in
body weight were observed. The haematocrit changes correlated with the loss of clinical efficacy (r =0.57 for ST-segment depression, and r =0.54 for exercise duration).
Conclusion:
Clinical nitrate tolerance may be observed despite maintenance of the arterial vasodilating effects, and tolerance is more
related to plasma volume expansion as a counterregulatory mechanism.
Received: 28 February 1996/Accepted in revised form: 5 July 1996 |
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Keywords: | Nitrate tolerance transdermal exercise test counterregulation digital photoplethysmography |
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