Smulyan Harold
Department of Medicine, Upstate Medical University, Syracuse, N.Y. , USA.
Adv Cardiol. 2007;44:302-314. doi: 10.1159/000096749.
This chapter traces the history of nitroglycerin from the initial nitration of glycerol to its widespread clinical use. The pharmacologic differences between nitroglycerin and nitric oxide are described, as well as their similar mechanisms of action. The vasoactivity of nitroglycerin requires a biochemical transformation, the nature of which remains incompletely understood. This poorly defined mechanism probably also relates to the phenomenon of nitroglycerin tolerance. By increasing the distensibility of muscular arteries, nitroglycerin slows pulse wave velocity, reduces wave reflections and alters the shape of the aortic pulse. This alteration reduces the systolic blood pressure and left ventricular after load and helps to explain the usefulness of nitroglycerin in angina pectoris, congestive heart failure and isolated systolic hypertension.
本章追溯了硝酸甘油从最初甘油硝化到其广泛临床应用的历史。描述了硝酸甘油与一氧化氮之间的药理学差异以及它们相似的作用机制。硝酸甘油的血管活性需要生化转化，其本质仍未完全明了。这种定义不明确的机制可能也与硝酸甘油耐受性现象有关。通过增加肌性动脉的扩张性，硝酸甘油减慢脉搏波速度，减少波反射并改变主动脉脉搏的形状。这种改变降低收缩压和左心室后负荷，有助于解释硝酸甘油在心绞痛、充血性心力衰竭和单纯收缩期高血压中的作用。
