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Additional resources for Advances in Nitrate Therapy
This was shown in late and/or early intervention studies with beta-blockers (propranolol, metoprolol, timolol) and calcium antagonists (diltiazem). Nifedipine is now being studied for this indication. An attempt to use nitrates for secondary prevention appears promising. The anti-ischemic effect of nitrates may be especially beneficial in early-intervention studies. A large secondary prevention trial of nitrates is now planned in South America. It should be remembered, however, that the only beta-blockers which fail to decrease mortality after acute myocardial infarction are those with sympathomimetic activity (alprenolol, oxprenolol).
Doses of 90 ± 25 mg, over 1 h, were used in patients with acute anterior wall myocardial infarction, showing ST elevation with tall-peaked T wave, without or with only minimal R wave. The dose of ISDN was titrated not to lower systolic blood pressure less than 100 mmHg and not to accelerate heart rate to over 100 beats/min. In patients with no significant alteration of QRS configuration in leads V2- V3 there was no effect. In those with disappearance of S wave and increase of R wave in V 2-V3 the ST-segment elevation was reduced from 14 to 5 mm after 1 h, the height of the tall-peaked T wave was reduced by 50%, left ventricular ejection fraction increased by 6%, and the left anterior descending coronary artery remained open.
8 mmHg. This reduction was fully achieved also during chronic therapy. 3 L min-1 m-2• This hemodynamic improvement was associated with sustained improvement in exercise capacity and in ST -segment depression. Long-Term Use of Nitrates in Angina Pectoris 37 Recently Distante et al  used a different approach to study the possibility of tolerance to long-term nitrate therapy. They evaluated the hemodynamic response to an acute infusion oflSDN, 1 mg/min, up to a maximal dose oflO mg, in eight patients with vasospastic angina chronically treated with high doses of transdermal ISDN, 150-300 mg daily.