Prevention of nitroglycerin tolerance with diuretics

Tolerance to prolonged nitroglycerin (NTG) may be due to drug-induced intravascular expansion. To test the hypothesis that concomitant diuretics may reduce volume expansion and thus prevent NTG tolerance, we studied 23 healthy volunteers randomized to hydrochlorthiazide or placebo before and during...

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Bibliographic Details
Published in:The American heart journal 1995-09, Vol.130 (3), p.522-527
Main Authors: Mohanty, Nita, Wasserman, Alan G., Walker, Pamela, Katz, Richard J.
Format: Article
Language:English
Subjects:
Administration, Oral
Administration, Sublingual
Adolescent
Adult
Analysis of Variance
Biological and medical sciences
Cardiovascular system
Double-Blind Method
Drug Tolerance
Female
Forearm - blood supply
Humans
Hydrochlorothiazide - administration & dosage
Male
Medical sciences
Nitroglycerin - administration & dosage
Pharmacology. Drug treatments
Plethysmography - drug effects
Plethysmography - methods
Reference Values
Time Factors
Vasodilation - drug effects
Vasodilator agents. Cerebral vasodilators
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Summary:Tolerance to prolonged nitroglycerin (NTG) may be due to drug-induced intravascular expansion. To test the hypothesis that concomitant diuretics may reduce volume expansion and thus prevent NTG tolerance, we studied 23 healthy volunteers randomized to hydrochlorthiazide or placebo before and during 74-hour continuous NTG exposure. Venodilator response to NTG was tested serially with venous forearm plethysmography. In the preNTG patch phase venodilator response was similar in both the placebo and diuretic groups. Venodilator capacity was compared after “acute” (2-hour) and “chronic” (74-hour) NTG exposure with NTG patches. Attenuation to NTG was seen in the placebo group, but NTG venodilator activity was fully maintained in the diuretic group. These data suggest that diuretics may be helpful in the prevention of NTG tolerance.
ISSN:0002-8703
1097-6744
DOI:10.1016/0002-8703(95)90361-5