Advances in Nitrate Therapy (2° Éd., 2nd ed. 1990. Softcover reprint of the original 2nd ed. 1990)

Nitrates have been for many years the cornerstone of cardiovascular therapy for various indications. Not only have nitrates stood the test of time for treatment of chronic stable angina pectoris, but the indications for them have markedly ex­ panded. They now include all forms of angina pectoris and myocardial ischemia, congestive heart failure and hypertensive emergencies. The beneficial effects of nitrates in all these conditions result from their vasodilatory properties, but it is still unclear whether the central or peripheral effects predominate in the thera­ peutic mechanism. Recently nitrates have been shown to fulfill the most important requirement for each and every drug - to reduce mortality. A large scale study revealed that isosorbide dinitrate, combined with hydralazine, reduced long-term mortality by 28% in patients with congestive heart failure. This finding will certainly stimulate research on nitrates, and it might be expected that interest in these drugs will markedly increase. The primarily used nitrates in clinical practice are nitroglycerin and the com­ plex organic nitrates, mainly isosorbide dinitrate. The organic mononitrates are now under clinical investigation, and isosorbide-5-mononitrate (IS-5-MN) appears to be especially promising.

A. Introduction and Mechanism.- 1. Introduction.- 2. The Mechanism of Action of Nitrates at the Cellular Level.- B. Indications.- 3. Stable Angina Pectoris.- 4. The Mechanism of Action of Nitrates in Angina Pectoris.- 5. Nitrates Compared and Combined with Other Antianginal Drugs.- 6. Unstable Angina Pectoris.- 7. Long-Term Use of Nitrates in Angina Pectoris.- 8. Silent Ischemia.- 9. Acute Myocardial Infarction.- 10. Congestive Heart Failure.- 11. Congestive Heart Failure and Valvular Diseases.- 12. Long-Term Nitrate Therapy in Congestive Heart Failure.- 13. Nitrates Combined and Compared with Other Drugs in Congestive Heart Failure.- 14. Systemic Hypertension, Arrhythmias and Cardiac Surgery.- 15. Pulmonary, Abdominal, and Peripheral Vascular Effects.- 16. Non-Cardiovascular Indications for Nitrates.- 17. Nitrates in Children and the Elderly.- C. Nitrate Formulations and Routes of Administration.- 18. Sublingual Tablets and Oral Spray.- 19. Intravenous Administration of Nitrates.- 20. Intracoronary Administration of Nitrates.- 21. Oral Administration of Nitrates.- 22. Mononitrates.- 23. Transdermal Administration of Nitrates.- 24. Buccal Nitroglycerin.- D. Pharmacology.- 25. Clinical Pharmacology.- 26. Side Effects and Drug Interactions.- 27. Dosage and Administration.- E. Conclusions.- References.