Nitratbehandlung

Organic nitrates are used for the treatment of angina pectoris symptoms, acute coronary syndrome and for acute and chronic heart insufficiency. In spite of the proven effectiveness of organic nitrates for acute cases, long-term therapy is limited by to the development of tolerance. Recent animal experiments, as well as clinical data, show that an endothelial dysfunction is also induced, a disquieting point, especially considering the negative prognostic impact of endothelial dysfunction. Due to these side effects, the published guidelines of the American Heart Association and the American College of Physicians do not recommend the use of long-term nitrates, such as mono- and dinitrate, for the treatment of stable angina pectoris. Rather, if good left ventricular function is present the calcium antagonist amlodipine should be used. In cases of appreciably reduced left ventricular function, there is a current discussion, based on the recently published A-HeFT study, as to whether a combination therapy with organic nitrates and the effective arteriole dilator hydralazine is beneficial for patients with severe heart insufficiency.