Effects of buccal nitrate on left ventricular haemodynamics and volume at rest and during exercise‐induced angina.

Silke, Bernard; Verma, S. P.; Frais, M. A.; Hafizullah, M.; Taylor, S. H.

doi:10.1111/j.1365-2125.1985.tb05094.x

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…Using the method of Thadani et al [21] to provoke pacing-induced myocardial ischaemia in patients with chronic obstruc tive coronary artery disease, we [ 11 ] found early and sus tained improvements in left ventricular filling pressures, peak filling rate (diastolic filling), and ejection fraction after treatment with 5 mg buccal nitroglycerin. These results are consistent with those of Silke et al [ 12] who found similar improvements in left ventricular volume changes with buccal nitroglycerin, although higher doses ( 10 mg) were used.…”

Section: <00001supporting

confidence: 83%

“…also appears to have doubtful efficacy in patients with stable angina; it is thus probably unsuitable for the man agement of unstable angina [10]. Buccal nitroglycerin has an unique delivery system which produces satisfac tory blood levels and haemodynamic effects within 1 min of administration [7,8,11,12], after which ade quate blood levels persist for up to 6 h [7,8,13], Theo retically it could be used during the acute phase of unsta ble angina and subsequently for long-term manage ment.…”

Section: Introductionmentioning

confidence: 99%

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Buccal Nitroglycerin and Intravenous Isosorbide Dinitrate in Unstable Angina

Lahiri¹,

Bowles²,

Brigden³

et al. 1989

Am J Noninvas Cardiol

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The relative efficacy of a sustained-action buccal nitroglycerin (5-10 mg) was compared with intravenous isosorbide dinitrate (3-6 mg/h) in 30 patients with unstable angina using a double-blind protocol. A nuclear probe was used to measure left ventricular ejection and filling for 3 h after acute administration, and ECG and blood pressure were recorded. Changes from basal data were analyzed by analysis of variance. A significant improvement in symptoms was accompanied by sustained improvements in ejection fraction, ejection rate, relative cardiac output, relative stroke volume, and peak filling rate. Both produced a non-linear fall in systolic and diastolic blood pressures with time (p = 0.0084 and p = 0.004, respectively), but did not alter heart rate. Buccal nitroglycerin produced greater changes than isosorbide dinitrate in systolic blood pressure (p = 0.014), ejection fraction (p = 0.046), relative stroke volume (p = 0.0054), and relative cardiac output (p = 0.054) at 3 h. The buccal route for nitrate delivery allows earlier and easier effective therapy for the management of unstable angina, comparable to intravenous isosorbide dinitrate. This application may be extended to management of unstable angina prior to hospital admission.

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Section: <00001supporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Buccal Nitroglycerin and Intravenous Isosorbide Dinitrate in Unstable Angina

Lahiri¹,

Bowles²,

Brigden³

et al. 1989

Am J Noninvas Cardiol

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“…In addition to the description of the haemodynamics of nicardipine, the left ventricular ejection fraction and volume were measured using a non-imaging scintillation probe (Nuclear Stethoscope-Bios Inc). As previously reported, this technique allows the left ventricular ejection fraction to be determined with a reproducibility of within <4% at rest and <5% during constant load supine bicycle exercise (Silke et al, 1985b). Over a similar dose range (1.25-10.0 mg), the haemodynamic dose-response effects described above were confirmed in 12 patients with similar demographic characteristics to the previous study.…”

Section: Intravenous Dose-response Studiessupporting

confidence: 80%

A review of the haemodynamic effects of nicardipine in ischaemic heart disease

Silke

Frais

Verma

et al. 1986

Brit J Clinical Pharma

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1 Nicardipine is a new peripherally selective slow calcium channel blocker. Like other dihydropyridine derivatives it appears to function as a systemic arteriolar vasodilator, and causes a significant reduction in left ventricular afterload. 2 Unlike the papaverine derivatives, and certain dihydropyridines, it does not demonstrate discernable cardiodepression in clinical situations. This appears due to selective vascular and myocardial sparing actions together with sympathetic activation and consequent counter-regulating corrective actions. 3 It has also been shown to improve coronary blood flow and to influence favourably myocardial metabolism. 4 Although there is currently limited information available, the combination of this drug with 3-adrenoceptor blocking agents appears to optimise its haemodynamic profile. It may also be of benefit in the treatment of patients with left ventricular failure. 5 Further studies are required to confirm these findings and to establish the place of nicardipine in the therapeutic management of patients with coronary artery disease.

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“…The doses and routes of drug administration were those which have been previously demonstrated to result in substantial pharmacodynamic effects (Silke et al, 1985a(Silke et al, , 1986; the route of drug administration was selected based on ease of administration and laboratory convenience. These considerations suggest that our data reliably describe the acute pharmacodynamic actions of celiprolol, nitrate and their combination in coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

A rest and exercise haemodynamic evaluation of a new cardio‐selective beta‐adrenoceptor blocker celiprolol alone and in combination with nitroglycerine in ischaemic heart disease.

Silke¹,

Verma²,

Frais³

et al. 1986

Brit J Clinical Pharma

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1 The symptomatic benefits of combining ,-adrenoceptor blockers and nitrates in angina pectoris are well recognised. Their actions on cardiac haemodynamics and volumes when combined have been poorly characterized. Accordingly this study investigated a new cardioselective ,-adrenoceptor blocking agent celiprolol and buccal nitroglycerine in 24 patients with angiographically documented coronary artery disease. 2 Following a control period, with confirmed stable haemodynamics, three groups (n = 8/group) of prospectively matched patients, were studied following intravenous celiprolol (8 mg), buccal nitrate (10 mg) or their combination. Haemodynamics and left ventricular ejection fraction (nuclear probe) were determined following each intervention. The actions of each regimen on the haemodynamics of exercise-induced angina were compared by exercise testing in the control state and following each regimen. 3 At rest, celiprolol did not alter haemodynamic parameters. Nitrate therapy reduced left ventricular filling pressure (pulmonary artery occluded pressure-PAOP) and volumes; the ejection fraction and heart rate increased. Combination therapy resulted in a highly significant reduction in left ventricular preload and afterload (PAOP and mean arterial blood pressure) at an increased left ventricular ejection fraction and reduced cardiac volumes; there was a trend to reduce cardiac double product (HR x SBP). 4 During exercise celiprolol reduced systolic blood pressure, heart rate and cardiac index; systemic vascular resistance index increased. Nitrate therapy reduced blood pressure and PAOP, and increased ejection fraction. Combination therapy reduced all components of the triple product (heart rate, systolic blood pressure and PAOP) without affecting the other haemodynamic or radionuclide parameters. 5 These data suggest improvements in cardiac function from the combination of celiprolol and nitrate therapy which were not achieved by either agent when used as monotherapy; they afford an interesting insight into the manner in which such widely utilised therapeutic modalities interact in coronary artery disease.

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Effects of buccal nitrate on left ventricular haemodynamics and volume at rest and during exercise‐induced angina.

Cited by 9 publications

References 32 publications

Buccal Nitroglycerin and Intravenous Isosorbide Dinitrate in Unstable Angina

Buccal Nitroglycerin and Intravenous Isosorbide Dinitrate in Unstable Angina

A review of the haemodynamic effects of nicardipine in ischaemic heart disease

A rest and exercise haemodynamic evaluation of a new cardio‐selective beta‐adrenoceptor blocker celiprolol alone and in combination with nitroglycerine in ischaemic heart disease.

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