The relevance of using organic nitrates in the modern therapy of stable coronary artery disease

H.F. Lysenko, O.I. Moiseienko


The article deals with the use of nitrates in modern therapy of coronary artery disease, angina pectoris. The mechanisms of action of nitrates and the main indications for the use of various dosage forms are considered. Short-acting nitrates (nitroglycerin and isosorbide dinitrate) remain mandatory standard component of therapy for angina pectoris. These drugs, due to the significant antianginal effect, can be used to relieve various forms of angina pectoris/effort angina, unstable (acute coronary syndrome), post-infarction, vasospastic. Long-acting nitrates are recommended as second-line drugs to prevent angina attacks. The article also discusses issues of tolerance to nitrates, the possibilities of its overcoming and the features of using these drugs in different groups of patients, describes the individual characteristics of nitrate use.


short-acting nitrates; isosorbide dinitrate; antianginal therapy


ESC guidelines on management of stable coronary artery disease // Eur. Heart J. — 2013. — 34. — Р. 2949-3003.

ACCF/AHA/ACP/AATS/PCNA/SCAI/STS. Guidelines for the diagnosis and management of patients with stable ischemic heart disease // JAC. — 2012. — 60(60). — Р. 2564-2603.

Рекомендації з діагностики та лікування стабільної ішемічної хвороби серця / Асоціація кардіологів України. — К., 2014.

Лутай М.І., Пархоменко О.М., Лисенко А.Ф., Голікова І.П. Пацієнт зі стабільною ІХС в Україні та Європі: результати 5-річного реєстру CLARIFY // УКЖ. — 2018. — № 4. — С. 19-30.

Opie L.H., Gersh B.J. Drugs for the Heart. — Philadelphia, Elsevier Inc., USA, 2005.

Thadani U. Medical therapy of stable angina pectoris / Abrams J. // Cardiology Clinics // Angina pectoris. — London, WB Saunders, 1991.

Информация о лекарственных средствах для специалистов здравоохранения. Лекарственные средства, действующие на сердечно-сосудистую систему. USPDI / Под ред. Машковского М.Д. — М.: РЦ «Фармединфо», 1997.

Doucet S., Malekianpour M., Theroux P. et al. Rando-mized Trial Comparing IV Nitroglycerin and Heparin for Treatment of Unstable Angina Secondary to Restenosis after Coronary Artery Angioplasty // Circulation. — 2000. — 101. — Р. 955-961.

GISSI-3 study group Six-month effects of early treatment with lisinopril and transdermal glyceryl trinitrate single and together withdrawn six weeks after acute myocardial infarction: the GISSI-3 trial // J. Am. Coll. Cardiol. — 1996. — 27. —

Р. 337-344.

Guidelines on the clinical investigation of anti-anginal medical products in stable angina pectoris (EMEA, CHMP). 2006.

Персонализованный подход к лечению стабильной стенокардии: согласованное мнение экспертов. Обзор публикаций // Medicine review. — 2018. — 1(48). — Р. 8-16.

Elliot H. Current Issues in Cardiovascular Therapy. — Martin Dunitz, Glasgow, UK, 1997.

Bassan M.M., Weiler-Ravell D., Shalev O. Comparison of the antianginal effectiveness of nifedipine, verapamil, and isosorbide dinitrate in patients receiving propranolol: a double-blind study // Circulation. — 1983. — 68. — Р. 568-575.

Walker J.M.,Curry P.V., Baily A.E., Steare S.E. A comparison of nifedipine once daily (Adalat LA), isosorbide mononitrate once daily and isosorbide dinitrate twice daily in patients with chronic stable angina // Int. J. Cardiol. — 1996. — 53. —

Р. 117-126.

Hill J.A., Feldman R.L., Pepine C.J., Conti C.R. Randomized double-blind comparison of nifedipine and isosorbide dinitrate in patients with coronary arterial spasm // Am. J. Cardiol. — 1982. — 49. — Р. 431-438.

Munzel T., Daiber A., Mulsch A. Explaning the phenomenon of nitrate tolerance // Circ Res. — 2005. — 97. — Р. 618-628.

Knorr M., Hausding М., Kroller-Schuhmacher S. et al. Nitroglycerin-induced endothelian dysfunction and tolerance involves adverse phosphorylation and S-glutathionylation ofendothelial nitric oxide synthase — beneficial effects of therapy with the AT1-receptor blocker telmisartan // Arterioscler. Thromb. Vasc. Biol. — 2011. — 31. — P. 2223-2231.

Oelze M., Knorr M., Kroller-Schon S. et al. Chronic the-rapy with isosorbide-5-mononitrate causes endothelian dysfunction, oxidative stress and a marked increase in vascular endothelin-1 expression // Eur. Heart J. — 2013. — 34. — P. 3206-3216.

Kurz S. Evidence for a casual role of the renin-angiotensin system in nitrate tolerance // Circulation. — 1999. — 99. —

P. 3181-3187.

Abshagen U. Controlled clinical studies of tolerance development and dosing problems in nitrate therapy // Herz. — 1996. — 21(Suppl. 1). — P. 23-30.

Reinchec N. Intermittent nitrate therapy in angina pectoris // Eur. Heart J. — 1989. — 10(Suppl. A). — P. 7-10.

Kloner R.A. Time course of the interaction between tadalafil and nitrates // J. Am. Coll. Cardiol. — 2003. — 42. — P. 1855-1860.

Copyright (c) 2018 HYPERTENSION

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2019


   Seo анализ сайта